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To describe the daily experience of patients with an automatic defibrillator (AD) implant and the adaptive changes of the patient.Qualitative and phenomenological research. Collection of data through; initially unstructured interview with half of the informants, semi-structured interviews through an open questions guide after the initial unstructured interviews and use of personal narratives of the informants. Analysis of the data using the Van Manen proposal.We analysed the interviews of 10 participants. We collected socio-demographic variables and identified the following themes, which respond to the question "How is life with an AD": It is life "with the two sides of the coin," living in constant wait and uncertainty, accepting change, developing adaptation strategies, renegotiating relationships and sexuality and it is to live transformed.The results of this study can be integrated into nurse clinical practice in areas such as valuation after discharge, changes in habits, control of treatment, notification of shocks, masking detection of symptoms and strategies that can jeopardise the bearer. Research needs to be developed that looks closer into the influence of other technological devices in people.

This study examines if C7-T1 manipulation results in changes in pressure pain thresholds (PPT) over bilateral C5-C6 zygapophyseal joints in asymptomatic subjects.Thirty subjects, 13 men and 17 women, without a current history of neck, shoulder, or upper extremity pain participated. Participants were randomly divided into 3 groups: experimental dominant group, subjects who received the manipulative thrust directed at the right side of the C7-T1 joint; experimental nondominant group, those who received the thrust on the left side of the C7-T1 joint; and a placebo group, those who received a sham-manual procedure. The outcome measure was the PPT on both right and left C5-C5 zygapophyseal joints, which was assessed at preintervention and 5 minutes postintervention by an assessor blinded to the treatment allocation of the subject. A 3-way repeated measures analysis of covariance was used to evaluate changes in PPT.The analysis of covariance revealed time x group (F = 32.3; P.001), time x side (F = 4.9; P.05), time x sex (F = 7.93; P.01), and time x group x sex (F = 7.606; P.001) interactions. Post hoc analyses found that (a) both experimental groups showed greater improvements in PPT than the placebo group (P.05), without significant differences between them (P.6); (b) the right side had greater increases in PPT in both experimental groups (P.05), but not within the placebo group (P.8); (c) men experienced greater increases in PPT levels than women, particularly in the experimental nondominant group (P.01). Within-group effect sizes were large for both experimental groups (d1), but small for the placebo condition (d0.2).These results suggest that a C7-T1 manipulation induced changes in PPT in both right and left C5-C6 zygapophyseal joints in healthy subjects.

Objective.—To assess the presence of trigger points (TrPs) in several head and neck muscles in subjects with chronic tension-type headache (CTTH) and in healthy subjects; and to evaluate the relationship of these TrPs with forward head posture (FHP), headache intensity, duration, and frequency. Background.—Tension-type headache (TTH) is a headache in which myofascial TrPs in head and neck muscles might play an important etiologic role. Design.—A blinded, controlled, pilot study. Methods.—Twenty-five CTTH subjects and 25 matched controls without headache were studied. TrPs in bilateral upper trapezius, sternocleidomastoids, and temporalis muscles were identified according to Simons et al's diagnostic criteria: tenderness in a hyperirritable spot within a palpable taut band, local twitch response elicited by snapping palpation, and elicited referred pain with palpation. A TrP was considered active if the subject recognized the evoked referred pain as familiar headache. If the evoked referred pain was not recognized as familiar headache, the TrP was considered as latent. Side-view pictures of each subject were taken in both sitting and standing positions in order to assess FHP by measuring the cranio-vertebral angle. Both measurements were made by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration. Results.—The mean number of TrPs on each CTTH subject was 3.9 (SD: 1.2), of which 1.9 (SD: 1.2) were active TrPs and 1.9 (SD: 0.8) were latent TrPs. Control subjects only exhibited latent TrPs (mean: 1.4; SD: 0.8). There was a significant difference between the CTTH group and the controls for active TrPs (P .05). Differences in the distribution of active and latent TrPs within each muscle were also significant for all the analyzed muscles (P < .01). CTTH subjects with active TrPs in the right upper trapezius muscle or left sternocleidomastoid muscle showed a greater headache intensity and duration, but not headache frequency, compared to those with latent TrPs (P < .05). Active TrPs in the right temporalis muscle were associated with longer headache duration (P < .01), whereas active TrPs in the left temporalis muscle were associated with greater headache intensity (P < .05). CTTH subjects with active TrPs in the analyzed muscles had a greater FHP than those with latent TrPs in both sitting and standing positions. Differences were only significant for TrPs in the left sternocleidomastoid and FHP in the sitting position (P < .01). Conclusions.—Active TrPs in upper trapezius, sternocleidomastoid, and temporalis muscles were associated with CTTH. CTTH subjects with active TrPs usually reported a greater headache intensity and longer headache duration than those with latent TrPs. CTTH subjects with active TrPs tended to have a greater FHP than CTTH subjects with latent TrPs.

Referred pain evoked by suboccipital muscle trigger points (TrPs) spreads to the side of the head over the occipital and temporal bones and is usually perceived as bilateral headache. This paper describes the presence of referred pain from suboccipital muscle TrPs in subjects with episodic tension-type headache (ETTH) and in healthy controls. Ten patients presenting with ETTH and 10 matched controls without headache were examined by a blinded assessor for the presence of suboccipital muscle TrPs. Diagnostic criteria described by Simons and Gerwin were adapted to diagnose TrPs, i.e. presence of tenderness in the suboccipital region, referred pain evoked by maintained pressure for 10 s, and increased referred pain on muscle contraction. Six ETTH patients (60%) had active TrPs and 4 had latent TrPs (40%). On the other hand, 2 control subjects also had latent TrPs. Differences in the presence of suboccipital muscle TrPs between both groups were significant for active TrPs (P

To assess the long-term effects on functional and mobility outcomes of two exercise interventions for the management of patients with ankylosing spondylitis.In an extended 12-mo follow-up of a randomized controlled trial, 40 patients who were diagnosed with ankylosing spondylitis according to the modified criteria of New York, allocated to control or experimental groups using a random numbers table, and who performed their respective exercise program at least three times per month, were included in this long-term study. The control group was treated during 15 sessions with a conventional exercise regimen in ankylosing spondylitis, whereas the experimental group received 15 sessions of exercises based on the treatment of the shortened muscle chains following the guidelines described by the Global Posture Reeducation method. These patients were followed up and assessed again 1 yr after entering the study, re-applying the same validated indexes: BASMI (Bath Ankylosing Spondylitis Metrology Index [tragus to wall distance, modified Schober test, cervical rotation, lumbar side flexion, and intermalleolar distance]), BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), and BASFI (Bath Ankylosing Spondylitis Functional Index).The intragroup comparison between follow-up and post-intervention data showed that both groups decrease their clinical and functional measures during the follow-up period. This decrease was only significant for lumbar side flexion and intermalleolar distance measurements, being more significant in the control group (P = 0.001 and P = 0.002, respectively). Intragroup differences between follow-up and pre-intervention assessments revealed that improvements in all mobility measures of the BASMI index and in the BASFI index were partially maintained at the 12-mo follow-up in the experimental group but not in the control group. The intergroup comparison (unpaired t test analysis) between changes on each outcome during the long-term follow-up (post-follow-up; and pre-follow-up) showed no significant differences in the decrease between post-intervention and follow-up data between the study groups. On the other hand, the intergroup comparison between pre-intervention and follow-up data revealed significant differences in almost all mobility measures of the BASMI index (except for cervical rotation) and in the BASFI index, in favor of the experimental group.An exercise regimen based on the Global Posture Reeducation method and focusing on specific strengthening and flexibility exercises of the shortened muscle chains offers promising short- and long-term results in the management of patients who have ankylosing spondylitis.

Objectives: A systematic review was performed to establish whether manual therapies have specific efficacy in reducing pain from tension-type headache (TTH). Methods: Computerized literature searches were performed in MEDLINE, EMBASE, AMED, MANTIS, CINAHL, PEDro, and Cochrane databases. Papers were included if they described clinical (open noncontrolled studies) or randomized controlled trials in which any form of manual therapy was used for TTH, and if they were published after 1994 in the English language. The methodologic quality of the trials was assessed using the PEDro scale. Levels of scientific evidence, based on the quality and the outcomes of the studies, were established for each manual therapy: strong, moderate, limited, and inconclusive evidence. Results: Only six studies met the inclusion criteria. These trials evaluated different manual therapy modalities: spinal manipulation (three trials), classic massage (one trial), connective tissue manipulation (two trials), soft tissue massage (one trial), Dr. Cyriax's vertebral mobilization (one trial), manual traction (one trial), and CV-4 craniosacral technique (one trial). Methodologic PEDro quality scores ranged from 2 to 8 points out of a theoretical maximum of 10 points (mean = 5.8 ± 2.1). Analysis of the quality and the outcomes of all trials did not provide rigorous evidence that manual therapies have a positive effect in reducing pain from TTH: spinal manipulative therapy showed inconclusive evidence of effectiveness (level 4), whereas soft tissue techniques showed limited evidence (level 3). Conclusions: The authors found no rigorous evidence that manual therapies have a positive effect in the evolution of TTH. The most urgent need for further research is to establish the efficacy beyond placebo of the different manual therapies currently applied in patients with TTH.

Forward head posture (FHP) and neck mobility were objectively assessed in 25 patients with chronic tension-type headache (CTTH) and 25 healthy controls. Side-view pictures were taken in a sitting position to measure the cranio-vertebral angle. A cervical goniometer was employed to measure the range of all cervical motions. Patients with CTTH showed a smaller cranio-vertebral angle (45.3 degrees +/- 7.6 degrees) than controls (54.1 degrees +/- 6.3 degrees), thus presenting a greater FHP (P0.001). Patients also had lesser neck mobility for all cervical movements, except for right lateral flexion (P0.01). There was a positive correlation between the cranio-vertebral angle and neck mobility. Within the CTTH group, a negative correlation was found between the cranio-vertebral angle and headache frequency, but neck mobility did not correlate with headache parameters. Further research is needed to define a potential role of FHP and restricted neck mobility in the origin or maintenance of TTH.

We describe a patient with successive attacks (40 to 90 minutes) of cluster-like headache associated with aphasia, and contralateral hemihypesthesia and hemiplegia. The condition can best be described as cluster-like headache aura status.

To evaluate the effect of bone marrow transplantation during childhood on gonadal function in postpubertal patients.We studied 19 post-pubertal patients (13 males, 6 females) aged 13-20 years, 2-9 years after bone marrow transplantation for diverse diseases. Fifteen patients had received multi-agent cytotoxic treatment and 6 had received cranial irradiation prior to transplantation; eleven patients received total body irradiation. Gonadal function was assessed by typifying Tanner's stages of pubertal development and by measuring testicular volume in males (Prader's orchidometer). Serum concentrations of luteinizing hormone, follicle-stimulating hormone, testosterone and 17-beta-estradiol were also measured.Twelve patients were found to have gonadal dysfunction of gonadal origin. Of these, three had not received total body irradiation.The results obtained show that gonadal dysfunction is frequent in patients treated with bone marrow transplantation. This damage can be attributed to both chemo- and radiotherapy but a synergistic effect between these treatments could not be excluded. The prepubertal status of patients at the moment of transplantation was not a protective factor against chemo- or radiotherapy-induced gonadal damage in our series.

The human insulin analogue, Lispro (Lys B28, Pro B29), is more similar to normal pancreatic insulin response to ingestion. Therefore, it could provide an alternative to the classical treatment of type-1 diabetes in childhood. The aim of this study was to analyze the response to insulin treatment with this analogue during 1 year.In a study group of twenty puberal diabetic patients (nine male and 11 female) with a mean age of 15.6 years (+/- SD) and with diabetes of a mean of 8.3 years (+/- 4.3 SD), classical intensive treatment, a combination of regular insulin (HR) and NPH insulin (Humulin NPH) was substituted for a new treatment with Lispro and NPH insulin in 3-4 doses. All patients had received diabetic education and performed at least four blood glucose tests daily and self monitoring. We analyzed the 6 months prior to the change in treatment (Group A) and the 12 months after the change (Group B). The amount of insulin (u/kg/day), the fast/intermediate insulin ratio in each dose, dietary modifications, the level of metabolic control given by the HbA1C average measured every 2 months, severe hypoglycemia and the patient s level of satisfaction with the new treatment were compared between the two groups.The number of daily doses, as well as the daily insulin intake, was the same in both groups (3.7 [+/- 0.6] doses/day; 0.9 [+/- 0.2] u/kg/day). With Lispro treatment the ratio fast/intermediate insulin was reduced. This reduction was statistically significant for the pre-breakfast dose (Classical = 65. 4 +/- 30% vs Lispro = 47.1 +/- 19.6%), and for the pre-lunch dose (Classical = 58.1 +/- 29.3% vs Lispro = 39 +/- 12.8%). Most patients did not need neither mid-morning or mid-afternoon doses. There were no modifications in body mass index. Although metabolic control improved slightly (Classical X A(b) A(1)c = 7 +/- 1.2 vs Lispro X A(b) A(1c) = 6.6 +/- 1.1), the difference was not statistically significant. Three patients had a severe hypoglycemic episode in the first 6 months with the new treatment pattern. All of them were satisfied with the new insulin.Intensive therapy with Lispro insulin combined with appropriate doses of basal insulin (NPH) can provide a good alternative in the treatment of diabetic teenagers.

Our aim was to compare the differences in the prevalence and the anatomical localization of referred pain areas of active trigger points (TrPs) between women with myofascial temporomandibular disorder (TMD) or fibromyalgia (FMS). Twenty women (age 46 ± 8 years) with TMD and 20 (age 48 ± 6 years) with FMS were recruited from specialized clinic. Bilateral temporalis, masseter, sternocleidomastoid, upper trapezius, and suboccipital muscles were examined for TrPs. TrPs were identified by palpation and considered active when the pain reproduced familiar pain symptom experienced by the patient. The referred pain areas were drawn on anatomical maps, digitalized and also measured. A new analysis technique based on a center of gravity (COG) method was used to quantitative estimate of the localization of the TrP referred pain areas. Women with FMS exhibited larger areas of usual pain symptoms than women with myofascial TMD (P

The aim of this study was to estimate the prevalence of migraine in the general Spanish population and its association with socio-demographic and lifestyle factors, self-reported health status, and co-morbidity with other conditions. We analyzed data obtained from adults aged 16 years or older (n = 29,478) who participated in the 2006 Spanish National Health Survey (SNHS), an ongoing, home-based personal interview which examines a nation-wide representative sample of civilian non-institutionalized population residing in main family dwellings (household) of Spain. We analyzed socio-demographic characteristics (gender, age, marital status, educational level, occupational status, and monetary monthly income); self-perceived health status; lifestyle habits (smoking habit, alcohol consumption, sleep habit, physical exercise, and obesity); and presence of other concomitant diseases. The 1-year prevalence of diagnosed migraine (n = 3,433) was 11.02% (95% CI 10.55–11.51). The prevalence was significantly higher among female (15.94%) than male (5.91%) and showed the highest value in the 31–50 years age group (12.11%). Migraine was more common in those of lower income (AOR 1.19, 95% CI 1.01–1.41) and who sleep

A seven month old male with Menkes' disease ("Kinky hair") is presented. Low ranges of copper and caeruloplasmin were found. The angiogram of all intracranial arteries revealed torturous form. Biopsy of an extracranial artery (branch of the temporal artery) was normal. Authors review previously reported cases and possible causes that can contribute to hypomyelination of central nervous system.

Authors describe one case of Cushing's disease in a old eight-year boy, with growth deficiency, pubic hair and obesity. He had hypercortisolism unresponsive to dexamethasone suppression (1 mg). The more interesting fact for localization of the lesion was the more than 50% suppression with 8 mg of dexamethasone, while tomographic studies of sella turcicaland CAT were normal. A 3 mm microadenoma was removed at transsphenoidal surgery. After surgery the patient had diabetes insipida and adrenal insufficiency. One year later all endocrinologic studies were normal. This fact underlines the importance that transsphenoidal surgery can have in the treatment of Cushing's disease.

A case of Cushing disease in a 5 4/12 year-old boy is reported. After adenomectomy was performed, he was considered as "cured" but he relapsed after nineteen months. In a second transsphenoidal surgery a 2 X 3 mm piece of pituitary tissue with adenomatous aspect, was removed. It was histologically constituted by normal pituitary cells and Crooke cells. As the patient was in a cortisol-deficient state a remission was established. Nowadays, since the cortisol response to hypoglycemia was positive, we are paying attention to the risk of relapse. We discuss the possibility of a hypothalamic lesion as the cause and different therapeutic strategies in order to be more selective.

Authors describe clinic and therapeutic results in seven hyperthyroid Graves' disease patients between ages of three and a half an 15 and a half (x: 11.2) years relating their results with those of literature. Most peculiar aspects of these cases were pretibial myxedema in two patients and lack of goiter in one of them. Results include T4 greater than 18.5 mcg/100 ml in five, T3 greater than 645 ng/100 in three and a relationship between T3/T4 greater than or equal to 20 in five. These results have been evaluated as signs of a bad prediction. After a two years treatment with antithyroid drugs remission was obtained in five cases, two of which relapsed again (40%). Authors recommend as initial treatment anti-thyroids drugs in high dosages with an individual lasting period of treatment using specific markers of remission (antibodies directed the receptor for TSH, triiodothyronine suppression test, relationship okt4/okt8).

Descent of the testes is essential for normal function, with cryptorchidism being associated with defective spermatogenesis. The postpubertal function of cryptorchid testicles seems to be related to the original location of the undescended testis and the age at the moment of treatment. The objective of this study was to evaluate the pubertal development and gonadal function in postpubertal patients treated for cryptorchidism during childhood.Twenty postpubertal males with a mean age of 17.35 years (range: 15-21 years) and treated for cryptorchidism during childhood were evaluated for pubertal development and gonadal function. A hormonal study which included basal determinations of testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), testicular volume assessed by Prader's orchidometer and semen analysis was performed on each patient.Complete virilization was observed in all patients. The start and development of puberty were normal in all cases (except one patient that started puberty at 10 years of age). Basal studies in all patients showed normal levels of LH and testosterone. FSH levels were increased in 3 patients and normal in the other 17 patients. Fourteen patients achieved normal spermatogenesis with more than 20 million spermatozoa/ml. In the other 7 patients (35%), 5 with unilateral cryptorchidism and 2 with bilateral cryptorchidism, the sperm count remained below 20 million with a range of 0.8 to 18.4 x 10(6) spermatozoa/ml. The three males with elevated levels of FSH also presented oligospermia.The results obtained show that pubertal development is normal after cryptorchidism. Impaired spermatogenesis is a major factor in undescended testes. Basal SH levels can be useful in predicting germinal damage secondary to cryptorchidism.

Girls diagnosed of type 1 diabetes mellitus during the prepubertal stage may present reduced longitudinal growth and have a tendency to be overweight after puberty starts. Our objective was to evaluate the growth, pubertal growth spurt, final height and weight gain of diabetic girls diagnosed of insulin dependent diabetes during the prepubertal period.We evaluated retrospectively the longitudinal growth and body mass index (BMI) of 17 girls diagnosed of type 1 diabetes before puberty, from the time of diagnosis until final height. The effects of age at diagnosis, evolution time, insulin therapy (conventional or intensified), insulin dose and metabolic control on growth were analyzed.The final height attained was 161 +/- 4 cm, which is within the target height range. The height at diagnosis (0.31 +/- 0.71) was normal in relationship to the reference population, showing a significant reduction upon reaching the final height (-0.18 +/- 0.77). The BMI was significantly increased when it was compared at final height (0.99 +/- 0.79) with the index obtained one year after the onset of diabetes (0.04 +/- 0.63). The insulin therapy regimen did not affect the evolution of the patients and no significant relationship existed between the age at diagnosis, duration of diabetes, daily insulin dosage or metabolic control and height or BMI.The final height of type 1 diabetic girls is reduced and adolescent diabetic girls have a tendency to be overweight. Metabolic control (for the range observed in these patients) or insulin dosage does not seem to affect the growth of diabetic girls.

We report the cases of 6 patients, all younger than 14 years of age, with differentiated thyroid carcinoma. None of the patients had a previous history of radiation exposure. All patients presented with an enlarged thyroid gland as a solitary nodule, with or without cervical nodes. The fine-needle aspiration cytological examination was found to be the most sensitive and specific, evidencing 5 pure papillary adenocarcinoma and 1 follicular. Our standard preoperative evaluation included thyroid scintiscan and ultrasound examination, laboratory studies of thyroid function and serum calcitonin, chest x-ray, fine needle aspiration and vocal cord examination. The treatment was total thyroidectomy and bilateral modified neck dissection. A whole body scan (WBS) with 131I was performed 6 weeks after surgery, followed by radioiodine therapy for ablation of thyroid remnants and treatment of metastases when present. Patients then began thyroid replacement treatment. The follow-up of the patients consisted of thyroglobulin and WBS. The microscopic carcinoma was found in the contralateral lobe in 100%. Lung metastases were detected in 2 patients. All of the patients have survived during a follow-up period ranging from 6 to 108 months.