Estudo dos r��cios trap��zio inferior/ trap��zio superior e grande dentado/ trap��zio superior, em exerc��cios com envolvimento das articula����es escapulo-tor��cica e gleno-umeral : recurso �� electromiografia de superf��cie

RESUMO: Introdu����o: A estabilidade din��mica relativa ao complexo articular do ombro depende de uma interac����o perfeita entre m��sculos da coifa dos rotadores e m��sculos escapulares, como o bin��mio rotador da esc��pula ��� trap��zio superior e trap��zio inferior e o grande dentado. A compreens��o dessas sinergias musculares em sujeitos assintom��ticos permite, em ��ltima inst��ncia, o desenvolvimento de linhas orientadoras de racioc��nio na abordagem cl��nica. Objectivo: Estudar o r��cio de activa����o entre os m��sculos trap��zio inferior e trap��zio superior e entre grande dentado e trap��zio superior, atrav��s de um conjunto de cinco exerc��cios aplicados a uma amostra de sujeitos assintom��ticos, estabelecendo uma hierarquia entre esses r��cios. Metodologia: Trata-se de um estudo descritivo, com uma amostra de 15 sujeitos saud��veis (n=9 homens; n=6 mulheres), com idades compreendidas entre os 19 e 27 anos (m��dia=21 anos, dp=2,24), tendo sido avaliados por um sistema de electromiografia de superf��cie, em dois momentos de recolha diferentes. Os exerc��cios foram realizados em cadeia cin��tica aberta, sem qualquer aplica����o de resist��ncias externas. Resultados: De entre os exerc��cios analisados com envolvimento escapulo-tor��cico e gleno-umeral simultaneamente, destacaram-se com melhor r��cio trap��zio inferior/trap��zio superior e grande dentado/trap��zio superior (activa����o dos m��sculos trap��zio inferior e grande dentado superior �� activa����o do trap��zio superior) os movimentos de flex��o do ombro at�� aos 90�� no plano sagital e a abdu����o do ombro at�� aos 90�� no plano da esc��pula, considerando ambas as recolhas. Nos exerc��cios apenas com envolvimento escapulotor��cico, destacaram-se com melhor r��cio os movimentos de adu����o e depress��o das esc��pulas bilateralmente com os membros superiores em repouso, seguido da abdu����o da esc��pula, com o ombro a 90�� de flex��o e mantendo a esc��pula em depress��o (���murro �� frente���), em ambas as recolhas. O exerc��cio de abdu����o do ombro at�� aos 90�� no plano frontal obteve sempre o pior r��cio muscular, nos dois momentos de recolha. Conclus��es: O presente trabalho estudou as interac����es dos m��sculos escapulotor��cicos em cinco exerc��cios realizados at�� aos 90�� de eleva����o do membro superior,em cadeia cin��tica aberta e sem recurso a resist��ncias externas. Ser��, eventualmente poss��vel, enquadrar os exerc��cios propostos nas fases de consciencializa����o e associa����o de reaprendizagem motora. Sugerem-se futuros estudos com uso de an��lise cinem��tica. --------------------ABSTRACT: Introduction: Stability of the shoulder and scapula depend upon a perfect interaction between rotator cuff of the shoulder and scapular muscles, such as upper and lower trapezius and serratus anterior. A deeper comprehension of these synergies in healthy subjects allows, ultimately, the development of a better reasoning in the clinical approach. Goal: To study the ratios between lower trapezius/ upper trapezius and between serratus anterior/ upper trapezius in five different exercises, applied to healthy subjects, presenting a hierarchy between ratios. Methods: It���s an observational descriptive study including 15 healthy subjects (n= 9 men; n=6 women) with ages between 19 and 27 years (mean of 21 years, SD of 2,24). Surface electromyography was used in two different recording moments. All the exercises were performed in open kinetic chain, without external resistance. Results: Of the exercises studied that involved the shoulder and scapula together, the best ratios between lower trapezius/upper trapezius and serratus anterior/ upper trapezius (greater activity for lower trapezius and serratus anterior and less for upper trapezius) were found in shoulder flexion to 90�� and in shoulder abduction to 90�� in the plane of the scapula, in both recording moments. Considering the exercises that included only the scapula, the best ratio were found in bilateral adduction and depression of the scapula with the upper limbs resting and in abduction of the scapula, while being in depression, with the shoulder flexed at 90��, considering both recordings. Shoulder abduction to 90�� in the coronal plane presented the worse ratio in both recording moments. Conclusions: This present paper studied the interaction of the scapula upward rotator muscles in five exercises performed below 90�� of shoulder flexion or abduction, in open kinetic chain, with no external resistance. It may be possible to associate our exercises with the motor learning phases of association and consciousness. Future studies are suggested with kinematic analysis.

Contributo para o desenvolvimento de uma metodologia que avalia a posi����o da omoplata: fidedignidade intra e interobservador e validade concorrente

RESUMO: Introdu����o: A rela����o cinem��tica entre as articula����es do CAO apresenta grande import��ncia na fun����o do MS, e �� por isso cada vez mais investigada e descrita. O posicionamento da omoplata ganha um importante papel para compreender as DCAO. �� indiscut��vel o importante papel da omoplata na din��mica do MS, bem como o posicionamento escapular como par��metro cl��nico de disfun����o do CAO. Todos estes factores criam a necessidade de desenvolver instrumentos de avalia����o da posi����o da articula����o ET. A grande maioria dos testes de avalia����o, restringem a sua avalia����o ��s disfun����es da articula����o GU, n��o integrando uma avalia����o mais din��mica e interactiva que respeite os pressupostos te��ricos inerentes ao REU. �� importante tamb��m que os m��todos de avalia����o sejam de f��cil aplicabilidade cl��nica e que avaliem fidedignamente e com validade os outcomes. Objectivos: Contribuir para o desenvolvimento de uma metodologia de avalia����o da omoplata em diferentes amplitudes do MS, atrav��s do estudo da validade concorrente, da fidedignidade intra e inter-observador. Metodologia: A amostra foi constitu��da por 20 elementos seleccionados por conveni��ncia, entre o corpo de discentes da ESS-IPS, sem hist��ria de disfun����o do CAO. Foi realizada uma an��lise cinem��tica ao MS de cada sujeito, usando um aparelho de an��lise por varrimento electromagn��tico, o FOB. Em cada sujeito foram ainda medidas, as dist��ncias escapulares em estudo, usando a fita m��trica. Cada m��todo de medi����o foi constitu��do por dois momento (teste e reteste), em cada momento, as medidas eram recolhidas por dois investigadores distintos. Resultados e Discuss��o: Foram considerados como positivos os resultados que se apresentassem acima do limiar de 0,5, que classifica uma correla����o como moderada a excelente. Os resultados da validade mostram que para o investigador 1 nas medidas M1e M2 apenas houve correla����o com valores excelentes a moderados at�� aos 30�� de eleva����o do MS. J�� para M3 apenas aos 30�� no plano da omoplata essa mesma correla����o n��o tem valores pr��ximos do cutpoint. Em M4 nenhum valor tem correla����o significativa com os valores do FOB, chegando mesmo a haver correla����o negativa para os 120�� no plano da omoplata. Em M5 apenas os 0�� mostram valores correlacionais excelentes a moderados. Para o investigador 2, em M1 e M2 �� semelhan��a do investigador 1, s�� existem valores de correla����o significativos at�� aos 30�� de eleva����o do MS. J�� para M3 todos os valores mostram excelente a moderada correla����o �� excep����o dos 120�� no plano frontal. Em M4 este investigador apresenta maus resultados. J�� em M5 os valores de correla����o s��o moderados aos 0�� e aos 90��. No que diz respeitos aos resultados dos CCI intra-observador,podemos afirmar que foi em M5 que estes valores mais se aproximaram do cut point. M1 e M2 s��o as medidas onde se encontram resultados menos satisfat��rios. �� aos 60�� que existem valores mais satisfat��rios, seguidos pelos 0�� e 30��, quando nos aproximamos de graus mais elevados, como 90�� e 120��, estes valores tendem a baixar. Quanto �� fidedignidade inter-observador para M1 apenas aos 90�� e aos 120�� houve valores de correla����o abaixo do cutpoint. Em M2, s�� os 60�� do plano sagital n��o teve valores acima do cutpoint, em M3 apenas os 30�� plano sagital n��o obtiveram valores acima do cut-point, o mesmo acontece para M3 aos 30�� plano da omoplata e em M5 aos 30�� e 120�� no plano frontal. Conclus��o: Os resultados deste estudo indicam que a metodologia em causa apresenta elevado grau de fidedignidade inter-observador, j�� no que toca �� fidedignidade intra-observador o grau de semelhan��a n��o �� t��o elevado. Tamb��m o erro associado �� medida n��o ultrapassou 1,5cm, sendo considerado baixo. Na validade concorrente conclu��mos que �� aos 0�� que a metodologia se torna uma op����o v��lida na aferi����o das dist��ncias medidas com uma boa a excelente concord��ncia com o FOB. As medidas consideradas como op����es v��lidas, nas diferentes amplitudes, podem funcionar como par��metros cl��nicos de caracteriza����o do posicionamento da omoplata, podendo vir a contribuir ainda para a caracteriza����o da orienta����o da mesma.-------------------- ABSTRACT:Introduction: The kinematic relationship between the joints of the CAO has great importance in the function of MS, which is why more and more investigated and described. The positioning of the blade gets an important role in understanding the DCAO. There is no doubt the important role of the scapula in the dynamics of MS as well as the positioning of scapular dysfunction as a clinical parameter of the CAO. All these factors create the need to develop tools for evaluating the place of articulation ET. Most assessment tests, restrict its assessment to GU joint disorders, not incorporating a more dynamic and interactive way that respects the theoretical assumptions inherent in the REU. It is also important that the methods are easy to apply clinical and reliably to assess the validity and outcomes. Objectives: To contribute to the development of a methodology for evaluating the scapula in different ranges of MS, through the study of concurrent validity, reliability of intra-and inter-observer. Methodology: The sample consisted of 20 selected elements for convenience, between the body of students of IPS-ESS with no history of dysfunction of the CAO. We performed a kinematic analysis of each subject to MS, using a scanning device for electromagnetic analysis, the FOB. In each subject were also measured, the scapular distances under study, using tape measure. Each method of measuring the time consisted of two (test and retest), in each moment, the measures were collected by two different investigators. Results and Discussion: We considered as positive results that were above the threshold of 0.5, which ranks as a moderate to excellent correlation. The results show that the validity for the researcher in an action M1e M2 was only correlated with moderate to excellent values up to 30�� of elevation of the MS. As for M3 only to 30�� in the plane of the scapula has the same correlation values near the cutpoint. M4 has no value in correlation with the values of the FOB, and even negative correlation to 120 �� in the plane of the scapula. In M5 show only the values 0 �� correlational excellent to moderate. For investigator 2 in M1 and M2 will be like an investigator, there are only significant correlation values up to 30�� of elevation of the MS. As for M3 all the values show excellent correlation to moderate with the exception of 120 �� in the frontal plane. In this researcher M4 has bad results. M5 already in the correlation values are moderate to 0�� and 90 ��. Regarding the results of ICC intra-observer, we can say that M5 was that these values come closest to the cut point. M1 and M2 are measures which are less than satisfactory results. At 60 �� there are more satisfactory values, followed by 0�� and 30��, when we approached the highest levels, such as 90 �� and 120 ��, these values tend to decrease. The inter-observer reliability for M1 only to 90 �� and 120 ��correlation values were below the cutpoint. In M2, only 60 of the sagital plane did not have values above the cutpoint in M3 only 30�� sagital plane did not obtain values above the cut-point, the same goes for M3 at 30 �� plane of the scapula and M5 at 30 �� and 120 �� in frontal plane. Conclusion: The results of this study indicate that the methodology in question has a high degree of inter-observer reliability, as far as intra-observer reliability is the degree of similarity is not as high. Also the error of measure did not exceed 1.5 cm, and is considered low. In concurrent validity conclude that it is at 0 �� the methodology becomes a valid option for the measurement of distances measured with a good to excellent agreement with the FOB. The measures considered as valid options in different amplitudes, can function as clinical parameters to characterize the positioning of the shoulder blade and could further contribute to the characterization of the orientation of the same.

O biofeedback cinem��tico na realiza����o de exerc��cios esc��pulo-tor��cicos

RESUMO: O Biofeedback cinem��tico na realiza����o de exerc��cios esc��pulo-tor��cicos Patr��cia Ribeiro; Ricardo Matias Desenho do estudo: Estudo quantitativo, experimental, prospetivo de fator ��nico. Objetivos: Determinar a efetividade do biofeedback cinem��tico tridimensional (3D) em tempo real, como informa����o de retorno extr��nseca, no reconhecimento da zona neutra da omoplata, em indiv��duos saud��veis; medir o desempenho temporal, atrav��s do tempo que os sujeitos demoram a atingir a posi����o pretendida, e o desempenho no percurso, atrav��s da diferen��a entre o percurso efetuado e aquele que seria o percurso mais curto, sem Informa����o de Retorno Extr��nseca (IRE), com Informa����o de Retorno Extr��nseca clinica verbal e palpat��ria (IRE-VP) e com informa����o de retorno extr��nseca visual cinem��tica (IRE-VC). Enquadramento: Reconhecer aquela que deve ser a posi����o adequada da omoplata e tomar consci��ncia da import��ncia dessa posi����o para a estabilidade e correto funcionamento da articula����o gleno-umeral �� uma tarefa dif��cil, pois a grande maioria do indiv��duos n��o t��m os conhecimentos necess��rios. �� reconhecido o contributo que a IRE tem na reaprendizagem motora, em especial na primeira fase da aprendizagem motora ��� a consciencializa����o. V��rios estudos se t��m debru��ado em avaliar a influencia da IRE na reabilita����o de indiv��duos com disfun����o do ombro, tendo-se limitado ao formato electromiogr��fico. No sentido de encontrar novas estrat��gias para facilitar o processo de reaprendizagem motora nestes indiv��duos, foi escolhido biofeedback cinem��tico tridimensional. M��todos: Participaram no estudo 60 sujeitos, sem queixas de dor no ombro, com idades compreendidas entre os 18 e os 54 anos, com um valor m��dio de 21,66 anos (��5.89), divididos aleatoriamente em tr��s grupos com uma tarefa comum: o reconhecimento da zona neutra da omoplata. Um grupo n��o recebeu qualquer tipo de IRE - Grupo Controlo (GC), outro grupo recebeu IRE-VP e outro recebeu IRE-VC. Para efeitos de an��lise da performance foram consideradas duas vari��veis: tempo e qualidade da execu����o. A abordagem estat��stica destas vari��veis consistiu numa an��lise de vari��ncia simples e num teste de compara����es m��ltiplas. Resultados: Observ��mos que o grupo controlo e o grupo IRE-VC efetuaram a tarefa pedida em menos tempo que o grupo IRE-VP (p<0.01) e que o grupo IRE-VC obteve melhores resultados no que respeita �� qualidade da execu����o da tarefa do que o GC e o grupo IRE-VP (p<0.01). Conclus��o: Pelos resultados obtidos, na tarefa de reconhecimento da zona neutra da omoplata, podemos concluir que o biofeedback cinem��tico �� mais efetivo na facilita����o da obten����o de melhor qualidade de execu����o da tarefa do que o feedback clinico ou a inexist��ncia de feedback e igualmente efetivo �� inexist��ncia de IRE no que respeita ao tempo demorado a reconhecer essa posi����o. -------------- ABSTRACT:Study Design: Single factor experimental design. Objectives: To determine the effectiveness of real time cinematic biofeedback as extrinsic information in the recognition of the neutral zone of the scapula in healthy subjects; to measure the temporal performance and quality of the execution without extrinsic feedback, with clinical feedback and with cinematic feedback. Background: To recognize the proper scapula position and to be aware of the importance of this position to the stability and correct function of the gleno-umeral joint is a difficult task, because most people don���t have the necessary knowledge. It is known that extrinsic feedback is effective in motor learning, specially in the early stages. There are several studies that evaluated the influence of extrinsic feedback in rehabilitation of shoulder dysfunctions, but only in the electromyography format. Material and Methods: Sixty healthy subjects were randomly divided into 3 groups that received no feedback (group 1 ��� control group), verbal and palpatory feedback (group 2) and real time cinematic feedback (group 3). The performance variables considered ��� time and quality of execution - were statistically analyzed with ANOVA one-way and multiple comparisons test. Results: Control group and group 3 executed the task in less time that group 2 (p<0.01) and group 3 executed the task with better quality than control group and group 2 (p<0.01). Conclusions: From the results of this study we conclude that in the studied task, the cinematic feedback is more effective to facilitate a better quality of execution than no feedback or clinical feedback and, regarding to time taken to attain the requested position, equally effective to no feedback.

Indicadores de progn��stico em utentes com disfun����o do ombro submetidos a uma interven����o terap��utica direcionada para a estabilidade din��mica da esc��pulo-tor��cica

RESUMO: Introdu����o/ Objetivo: Segundo a revis��o sistem��tica de Chester e colaboradores (2013b)apenas dois fatores de progn��stico demonstraram uma associa����o consistente com o resultado que foram a dura����o dos sintomas e a funcionalidade na avalia����o inicial. O objetivo do estudo �� identificar indicadores de bom e mau progn��stico em utentes com disfun����o do complexo articular do ombro (DCAO), tendo por base, aspetos da avalia����o inicial do utente e crit��rios de alta de aboli����o da dor, aumento da funcionalidade e da estabilidade din��mica considerando uma interven����o terap��utica direcionada para o aumento da estabilidade din��mica da esc��pulo-tor��cica. Metodologia: Efetuou-se um estudo de coorte cl��nico retrospetivo. Para tal, aplicou-se um protocolo de interven����o terap��utica e analisou-se os resultados. A amostra foi constitu��da por 82 indiv��duos com DCAO [53 com s��ndrome do conflito subacromial (SCSA) e 29 com instabilidade da glenoumeral (IGU)], residentes nos distritos de Lisboa, Set��bal e Santar��m com o intuito de iniciar tratamento de fisioterapia. A an��lise dos dados foi efetuada tendo em considera����o dois procedimentos: an��lise univariada (atrav��s do m��todo de Kaplan-Meier para cada CVP) e an��lise multifatorial (pela an��lise de regress��o de Cox e regress��o log��stica nos grupos de utentes com SCSA, IGU e DCAO). Resultados: O tempo mediano de continua����o no tratamento em fisioterapia foi de 7 semanas para os utentes com SCSA e 6 semanas para utentes com IGU. Segundo o teste de Logrank, na an��lise univariada, existem sete e oito covari��veis preditoras (CVP) com associa����o estatisticamente significativa (p<0,05) para o subgrupo SCSA e IGU, respectivamente. De acordo com estes resultados, a primeira parte da DASH e a SPADI s��o as ��nicas CVP com associa����o comuns ��s duas disfun����es. Pela an��lise multifatorial e, em congru��ncia com o teste de Wald, nenhuma das CVP contribui estatisticamente para o modelo preditivo de continuidade do tratamento de fisioterapia em qualquer um dos tr��s modelos estudados: subgrupo SCSA, subgrupo IGU e utentes com DCAO. Conclus��o: Por uma an��lise univariada verificou-se que existem CVP associadas �� alta dos tratamentos em fisioterapia e estas n��o s��o as mesmas em ambas as DCAO. Contudo, a magnitude do efeito de cada CVP nos modelos multifatoriais definidos para os grupos de utentes com SCSA, IGU e DCAO n��o demonstraram valor estatisticamente significativo pelo que n��o foi poss��vel determinar modelos de progn��stico em utentes com DCAO.-------------ABSTRACT: Background/ Purpose: According with the systematic review from Chester and collaborators (2013b) just two prognostic factors demonstrated a consistent association with the outcome: the duration of symptoms and functionality in the initial assessment. The purpose of the study is to identify indicators of good and poor prognosis in patients with shoulder���s dysfunctions, based on aspects of the initial assessment and discharge criteria of absence of pain, increased functionality and dynamic stability considering a therapeutic intervention used to increase the dynamic stability of scapulo-thoracic. Methodology: It was conducted a retrospective study of clinical cohort. For this purpose it was applied a protocol with therapeutic intervention and the results were analyzed. The sample consisted of 82 individuals with shoulder���s dysfunction (53 with subacromial impingement (SIMP) and 29 with shoulder instability (SINS) residing in the districts of Lisbon, Set��bal and Santar��m in order to start physiotherapy. Data analysis was performed taking into account two procedures: univariate analysis [using the Kaplan-Meier method for each co-variant predictor variable (CVP)] and multifactorial analysis [analysis by Cox regression and logistic regression on groups of patients with SIMP, SINS and shoulder���s dysfunction (SD)]. Results: The median time of follow-up treatment at physical therapy was 7 weeks for patients with SIMP and 6 weeks for patients with SINS. According to the Logrank test in the univariate analysis, there are seven and eight CVP with a statistically significant association (p<0.05) for the patients with SIMP and SINS, respectively. According to these results, the first part of the DASH and SPADI are the only CVP common to both disorders association. By multifatorial analyses, and in agreement with the Wald test, none of the CVP contributes statistically to the predictive model of continuity of physiotherapy treatment in any of the three studied models: patients with SIMP, patients with SINS and patients with SD. Conclusion: In an univariate analysis, it was verified that there are CVP associated with discharge from treatments of physical therapy and these are not the same in both SD. However, the magnitude of effect of each CVP in multifactorial models for defined patients groups with SIMP, SINS and SD showed no statistically significant. Therefore, it was not possible to determine prognostic models for patients with SD.

Auto-refer��ncia de sintomas de les��es m��sculo-esquel��ticas ligadas ao trabalho LMELT numa grande empresa em Portugal

RESUMO - A dor, inc��modo ou desconforto ao n��vel m��sculo-esquel��tico, sobretudo devido a situa����es e/ou postos de trabalho com elevadas exig��ncias ao n��vel postural, de aplica����o de for��a, de repetitividade ou por incorrecta distribui����o das pausas, �� aceite como um indicador de situa����es de risco pass��veis de se encontrarem na g��nese de les��es m��sculo- -esquel��ticas ligadas ao trabalho (LMELT) (Stuart-Buttle, 1994). No sentido de avaliar a preval��ncia de sintomas de LME, efectuou-se um estudo numa grande empresa da ind��stria de componentes para autom��veis na regi��o de Lisboa durante o ano de 2001. Utilizou-se um instrumento de recolha de informa����o constru��do a partir de uma adapta����o do question��rio n��rdico m��sculo-esquel��tico (QNM) (Kuorinka et al., 1987). Com o apoio do servi��o de sa��de ocupacional da referida empresa, o question��rio foi entregue a todos os trabalhadores, obtendo-se uma taxa de respondentes de 63,2% (n = 574). A popula����o em estudo �� maioritariamente do sexo feminino (83,9%), tem idades compreendidas entre os 18 e os 65 anos e a classe modal situa-se entre os 26 e os 33 anos (23,3%). Os resultados evidenciam uma alta preval��ncia de sintomatologia de LME e diferen��as significativas de sintomas entre as categorias profissionais (1) operadores de m��quina de costura, (2) trabalhadores dos armaz��ns e de transporte de mercadorias e (3) trabalhadores da log��stica, qualidade e escrit��rios. Os operadores apresentam ��ndices superiores e diferentes (p < 0,05) de sintomatologia nos ��ltimos doze meses ao n��vel da regi��o cervical, ombros, cotovelos, ancas/coxas, pernas/joelhos e tornozelos/p��s e nos punhos nos ��ltimos sete dias. No presente estudo, a an��lise dos dados obtidos parece indicar que a natureza e as caracter��sticas da actividade de trabalho do grupo profissional operadores de m��quina de costura (flex��o cervical > 20��, trabalho muscular predominantemente est��tico ao n��vel da articula����o dos ombros, eleva����o dos membros superiores > 45��, ortostatismo e exig��ncias elevadas ao n��vel dos punhos/m��os) est��o implicadas no desencadear da sintomatologia auto- -referida.

Impact of an occupational gym program on flexibility in office workers

The problem of work-related musculoskeletal disorders is a rising concern in the companies. Thus, occupational gym has emerged as a possible solution to this problem because it leads to changes in the lifestyle by promoting health and physical activity. In this regard, this study purposes to evaluate the impact of an occupational gym program in the neck and shoulder flexibility in office workers. In order to evaluate the levels of flexibility, a universal goniometer was used for pre and post occupational gym program implementation. The program had an extension of three months, with 15 minutes sessions twice a week. The sample consisted in an intervention group comprised of 30 elements and a control group composed of 8 elements. The results suggest that there were improvements in flexibility at the cervical spine and shoulder segments levels. The increase on flexibility between the two time points in the intervention group was significant, unlike the control group that presented only slight improvements.

Pseudo-myocardial infarction during an episode of herpes zoster

The patient arrived at the emergency unit with a history of acute myocardial infarction, for which she was treated. Without improvement in the pain, the patient developed heart failure and underwent a hemodynamic study, which showed normal coronary arteries and extensive ventricular impairment. During evolution, the clinical findings improved and herpes zoster appeared on the right shoulder. In a few months the clinical findings subsided, and the findings of the electrocardiogram, chest X-ray, and ventricular function were normal. The patient is currently asymptomatic.

Avalia����o sensoriomotora do complexo articular do ombro : valida����o de um protocolo

Introdu����o: S��o escassas as medidas objetivas, v��lidas e consistentes da fun����o sensoriomotora do complexo articular do ombro (CAO). Objetivos: desenvolvimento e valida����o de um protocolo de avalia����o sensoriomotora do CAO. Materiais e m��todos: 40 Sujeitos (16 atletas e 24 n��o atletas) completaram 6 momentos de teste, 3 por cada um de 2 investigadores. Em cada momento avaliou-se a NPA pelo Biodex System 3, na eleva����o do bra��o no plano da omoplata a 80�� e 160��, e na rota����o externa (RE) a 45�� e 80�� , bem como o controlo postural do CAO avaliou-se pela plataforma Rsscan. Resultados/Discuss��o: Todas as vari��veis apresentaram estabilidade temporal, exceto os erros a 80�� na RE (p=0,021) e 80�� no PO (p=0,006), nos atletas, para o Investigador 1, e as componentes do CP nos n��o atletas, para o investigador 2. Os ICC���s foram globalmente baixos, apresentando valores moderados no grupo de n��o atletas, para o Investigador 2, no comprimento (0,862) e velocidade m��dia do CP (0,852). Excluindo a ��rea do CP no grupo de n��o atletas (p=0,030), n��o houve diferen��as significativas nas m��dias entre observadores. Verificaram-se correla����es fortes entre as componentes do CP, mas n��o ocorreram correla����es fortes entre estas e as da NPA. Conclus��es: Os resultados poucos consistentes, n��o permitem retirar conclus��es s��lidas, impossibilitando assumir o protocolo como fi��vel e v��lido na avalia����o sensoriomotora do CAO.

Lymnaea Diaphana; a study of Topotypic specimens (Pulmonata: Lymnaeidae)

A description of the species Lymnaea diaphana King, 1830 is presented, on the basis of material collected at its type-locality, San Gregorio, on the north coast of the Strait of Magellan, in the Chilean province of Magallanes. It may be identified by the following characters taken together: adult shell over 10 mm in length, whorls inflated, regularly convex, separated by a well-marked suture, aperture ovate occupying about half the shell length; renal organ forming an approximately right angle with the ureter; pouch of the oviduct well noticeable high on the right ventral surface and on the right side of the nidamental gland; uterus bent to the right into an approximately right angle; body of the spermatheca projected into the pulmonary cavity and adhered to the pericardium and to the roof of the pulmonary cavity; spermiduct highly sinuous, folding dorsalward between the left half of the oviduct and the left shoulder of the nidamental gland, and then winding on ventralward to reach the prostate on the middle line; prostate voluminous, convex on the left, pushed in on the right, with a deep dorsal furrow corresponding to a fold which projects into the prostatic lumen and is more developed at the fore half of the organ; apical end of the penial sheath with about six minute protuberances corresponding to inner chambers; prepuce from about as long about twice as long as the penial sheath, with some variation beyond those limits; lateral teeth of the radula basically tricuspid, with a usually simple ectocone which may show a bifid or trifid point. A diagnosis between lymnaea diaphana and three other lymnaeids which also occur in South America and were previously studied by the author - L. columella, L. viatrix and L. rupestris - is presented.

Physa Marmorata Guilding, 1828 (Pulmonata: Physidae)

A description of Physa marmorata Guilding, 1828, based on material collected at its type-locality, the Caribbean island of Saint Vincent, is presented. The shell is thin, horn-colored, surface very glossy, diaphanous. Spire acute, elevated; protoconch distinct, rounded-conical, reddish-brown; five not shouldered, broadly convex whorls with subobsolete spiral lines and thin growth lines. Aperture elongated, 1.4-2.0 times as long as the remaining shell length, narrow obovate-lunate; upper half acute-angled,lower half oval,narrowly rounded at the base, outer lip sharp, inner lip completely closing the umbilical region; a very distinct callus on the parietal wall; columellar lip with a low ridge gradually merging into the callus. ratios: shell width/shell length = 0.44 - 0.52 (mean 0.47); spire length /shell lenght = 0.33-0.41 (mean 0.39); aperture length/shell lenght = 0.59-0.67 (mean 0.62). Oral lappets laterally mucronate, foot spatulate with deeply pigmented acuminate tail. Mantle reflection with 6-10 short triangular dentations covering nearly half the right surface of the body whorl, and 4-6 covering a part of the ventral wall. Body surface with tiny dots of greenish-yellow pigment besides melanin. Renal tube tightly folded in toa zigzag course. Ovotestis diverticula acinous, laterally pressed against each other around a collecting canal. Ovispermiduct with well-developed seminal vesicle. oviduct highly convoluted, merging into a less convoluted nidamental gland which narrows to a funnel-shaped uterus and a short vagina. Spermathecal body oblong, more or less constricted in the middle and somewhat curved; spermathecal duct uniformly narrow, a little longer than be body. About 20 prostatic diverticula, simple, bifurcate or divided into a few short branches, distalmost ones assembled into a cluster. Penis long, nearly uniformly narrow; penial canal with lateral opening about the junction of its middle and lower thirds. Penial sheath with a bulbous terminal expasion the tip of which isinserted into the caudal end of the prepuce. Prepuce shouldered, much wider than the narrow portion of the penial sheath. Penial sheath/prepuce ratio about 2.08 (1.45-2.75). The main extrinsic muscles of the penial complex are a retractor, with a branch attached to the bulb, and another to the caudal end of the penial sheath; and a protractor, with a branch attached to the shoulder of the prepuce and adjoining area of the penial sheath, and another to the caudal end of the penial sheath. Egg capsule C-shaped, with 10-30 elliptical eggs (snails 10mm long) measuring about 1.10 mm (0.90-1.32) through the long axis and surrounded by an inner and an outer lamellate membranes. Jaw a simple obtusely V-shaped plate. radula will be described separately.

Acute flare induced by the calcific tendonitis of the rotator cuff: inhibition of IL-1 a potential therapeutic target?

Introduction: Calcific tendonitis of rotator cuff is observed on plainradiographs in 10% of adults, but remains asymptomatic in half thesecases. Sometimes, these calcifications induce acute flares withmassive inflammation similar to gout or CPPD crisis. Analgesics/anti-inflammatory medications are usually not sufficient to controlssymptoms in these situations. Local steroid infiltration with or withoutremoval of the calcific deposition with a needle aspiration may beuseful. A new approach could be IL-1 inhibitors. Indeed, basic calciumphosphate crystals are capable of stimulating the release of activeIL-1&#946; in vitro. These crystals trigger IL-1&#946; release, in an analogousmanner to MSU crystals in acute gout, suggesting that IL-1&#946; blockademay be clinically useful.Case presentation: This report describes a 70-year old woman withacute rest pain of the right shoulder since 48 hours. On examination,we found massive limitations of active and passive movements. Thepatient evaluated, on the visual scale, her symptoms at 10/10 the nightand 5/10 the day. The radiography and showed a rounded, 8 mmcalcification in the subscapularis tendon. The ultrasound aspectrevealed a heterogeneous calcification partially non solid, surroundedby massive inflammation on Doppler. C-reactive protein anderythrocyte sedimentation rate were high (74 mg/ml, 54 mm/hour).The patient received subcutaneous injections of anakinra: 100 mgdaily for 3 days (D1-D3). We evaluated the patient in our consult at dayD1, D2, D3, D7, D16 and by phone at D70.This treatment rapidly relieved the inflammatory symptoms (within afew hours with no relapse). The mobility of the shoulder, the biologicsparameters improved and the size of the calcification as well thedegree of inflammation regressed on ultrasound after 3 days.Conclusion: This is the first report of a woman with an acute flareinduced by calcific tendonitis who received anakinra. IL-1 inhibitionmay be a therapeutic target in calcific tendonitis. To analyse thisresponse more precisely and elaborate definitive conclusions, aprospective pilot study is on-going in our ambulatory institute.

Divergent and convergent margins in the north-western Alps - Confrontation to actualistic models

Divergent and convergent margins actualistic models are reviewed and applied to the history of the western Alps. Tethyan rifting history and geometry are analyzed: the northern European margin is considered as an upper plate whereas the southern Apulian margin is a lower plate; the Breche basin is regarded as the former break-away trough; the internal Brianconnais domain represents the northern rift shoulder whilst the more external domains are regarded as the infill of a complex rim basin locally affected by important extension (Valaisan and Vocontain trough). The Schistes lustres and ophiolites of the Tsate nappe are compared to an accretionary prism: the imbrication of this nappe elements is regarded as a direct consequence of the accretionary phenomena already active in early Cretaceous; the Gets/Simme complex could orginate from a more internal part of the accretionary prism. Some eclogitic basements represent the former Apulian margin substratum (Sesia) others (Mont-Rose) are interpreted as the former edge of the European margin. The history of the closing Tethyan domain is analyzed and the remaining problems concerning the cinematics, the presence/absence of a volcanic arc and the eoalpine metamorphism are discussed.

Impact of duration of chest tube drainage on pain after cardiac surgery.

OBJECTIVE: This study was designed to analyze the duration of chest tube drainage on pain intensity and distribution after cardiac surgery. METHODS: Two groups of 80 cardiac surgery adult patients, operated on in two different hospitals, by the same group of cardiac surgeons, and with similar postoperative strategies, were compared. However, in one hospital (long drainage group), a conservative policy was adopted with the removal the chest tubes by postoperative day (POD) 2 or 3, while in the second hospital (short drainage group), all the drains were usually removed on POD 1. RESULTS: There was a trend toward less pain in the short drainage group, with a statistically significant difference on POD 2 (P=0.047). There were less patients without pain on POD 3 in the long drainage group (P=0. 01). The areas corresponding to the tract of the pleural tube, namely the epigastric area, the left basis of the thorax, and the left shoulder were more often involved in the long drainage group. There were three pneumonias in each group and no patient required repeated drainage. CONCLUSIONS: A policy of early chest drain ablation limits pain sensation and simplifies nursing care, without increasing the need for repeated pleural puncture. Therefore, a policy of short drainage after cardiac surgery should be recommended.

Reversible behavioural autistic-like regression: A manifestation of a special (new?) epileptic syndrome in a 28-month-old child. A 2-year longitudinal study .

A 28-month-old boy was referred for acute onset of abnormal head movements. History revealed an insidious progressive regression in behaviour and communication over several months. Head and shoulder 'spasms' with alteration of consciousness and on one occasion ictal laughter were seen. The electroencephalograph (EEG) showed repeated bursts of brief generalized polyspikes and spike-wave during the 'spasms', followed by flattening, a special pattern which never recurred after treatment. Review of family videos showed a single 'minor' identical seizure 6 months previously. Magnetic resonance imaging was normal. Clonazepam brought immediate cessation of seizures, normalization of the EEG and a parallel spectacular improvement in communication, mood and language. Follow-up over the next 10 months showed a new regression unaccompained by recognized seizures, although numerous seizures were discovered during the videotaped neuropsychological examination, when stereotyped subtle brief paroxysmal changes in posture and behaviour could be studied in slow motion and compared with the 'prototypical' initial ones. The EEG showed predominant rare left-sided fronto-temporal discharges. Clonazepam was changed to carbamazepin with marked improvement in behaviour, language and cognition which has been sustained up to the last control at 51 months. Videotaped home observations allowed the documentation of striking qualitative and quantitative variations in social interaction and play of autistic type in relation to the epileptic activity. We conclude that this child has a special characteristic epileptic syndrome with subtle motor and vegetative symptomatology associated with an insidious catastrophic 'autistic-like' regression which could be overlooked. The methods used to document such fluctuating epileptic behavioural manifestations are discussed.