ALGIAS CRANIOFACIAIS - UM ROTEIRO PARA O EXAME FISICO DIRIGIDO

Craniofacial pain is a frequent challenge for the physician anamnesis with the goal to obtain specific and useful information about symptoms in craniofacial pain. It can be improved by identifying aching points. In the article, the authors present a practical and specific schedule for physical examination to be applied in patients with chronic pain. This specific schedule, which has proved useful in detecting the exact anatomic sites of pain, has a sequence ordered which includes palpation and inspection of muscles, nerves and arteries.

Hemoglobin as AS/alfa talassemia - Importância diagnóstica

Sickle Cell disease is a generic term for a group of genetic disorders characterized by the predominance of hemoglobin S. These disorders include Sickle Cell anemia, the Sickle Cell beta Thalassemia syndromes and Hemoglobinopathies in which hemoglobin S is in association with another abnormal hemoglobin, such as hemoglobin S/C. The Sickle Cell trait (hemoglobin AS) associated with Alpha Thalassemia presents alterations in the red blood cells morphology, usually absent in the heterozygous for this hemoglobin variant. The interaction between hemoglobin Sand alpha Thalassemia has been described as one of the factors responsible for the improvement in the clinical picture of homozygous of hemoglobin S (Sickle Cell Anemia), decreasing the number of episodes of pain. The genetic mechanisms of this influence are evaluated using molecular analyses of the human globin genes. With the objective of verifying the presence of alpha Thalassemia in heterozygous of hemoglobin S, with anemia, sent to the Laboratory of Hemoglobins, Department of Biology, UNESP, São José do Rio Preto, SP, we analyzed 1002 blood samples with Sickle Cell trait, in the period from 1990 to 1998. The samples were picked with EDTA 5% as anticoagulant, after previous authorization of the carriers. Appropriated counseling and management requires definitive diagnosis. For the laboratorial diagnosis the blood samples were submitted to electrophoretic procedures in alkaline and acid pH and cytological evaluation of hemoglobin H. The electrophoretic procedures confirmed the presence of hemoglobin AS. The cytological evaluation evidenced the presence of alpha Thalassemia. Of this total analyzed, 16(1,59%) blood samples presented the association between hemoglobin AS and alpha Thalassemia and two individuals belonged of the same family. Our results addressed us to suggest to the routine laboratories, that is important to accomplish the research of alpha Thalassemia among the Sickle Cell trait, with anemia, to verify the interaction with alpha Thalassemia, supplying to the carriers a important information on its hematological profile, genetic pattern of hemoglobinopathies and the appropriated counseling. Rev.bras.hematol.hemoter.,2000,22(3):388-394.

Estudo comparativo de vias de acesso cirúrgico na contracepção cirúrgica feminina: Microlaparoscopia versus minilaparotomia

Purpose: to compare in a retrospective way, 51 women who underwent tubal ligation, 30 through microlaparoascopy (Gmicrol) and 21 through minilaparotomy (Gminil). Methods: the analyzed parameters were: total time for accomplishment of the procedure and the surgical technique, time of hospital stay and return to the habitual activities after the surgery, postoperative pain, morbidity, satisfaction degree and esthetic effect, considering values of p<0,05 as significant, and also standard cost. Results: Gmicrol took less time to accomplish the surgery than the Gminil (43 against 57 minutes respectively, p<0,05), less time to accomplish the surgical technique (6.48 against 30.32 minutes respectively, p<0,05), and lower hospital stay (9,90 hours as against 41,7 hours respectively, p <0,05). There was no significant difference between the two groups regarding time to return to the habitual activities after surgery. To evaluate postoperative pain, a scale of 0-10 it was applied. Gmicrol present a lower pain score on the 1st and 2nd postoperative days (1.13 and 0.26 to Gmicrol and 4.52 and 1.14 to Gminil, respectively, p<0,05). There was no significant difference between immediate postoperative the most common complaint being pain at the site of pain and that on the 3rd postoperative day. Gminil presented a higher morbidity rate incision. To evaluate the satisfaction degree and esthetic effect, numeric values were attributed to as good, regular, poor and very bad as answered by the patiets. Gmicrol presented a higher satisfaction degree (p<0,05) and better esthetic effect as compared to Gminil (p <0,05). The microlaparoscopy standard cost was R$ 109.30 being lower than that of minilaparotomy. Conclusions: tubal ligation by microlaparoscopy, under local anesthesia and conscious sedation presented some advantages compared to minilaparotomy.

Sleep bruxism and temporomandibular disorder: Clinical and polysomnographic evaluation

Objective: To seek better understanding of chronic musculoskeletal facial pain and its relation to sleep bruxism, by comparing patients with sleep bruxism, with and without temporomandibular disorder. Design: Forty sleep bruxism patients were evaluated according to the Research Diagnostic Criteria for Temporomandibular Disorders: group A-20 patients with myofascial pain, 3 men, 17 women; average age 32.7 yr; mean duration of pain 4.37 yr; group B-20 without myofascial pain, 5 men, 15 women; average age 30.8 yr. Sleep and bruxism were evaluated in one-night polysomnography. Results: There were no statistically significant differences for bruxism and sleep variables of the two groups: number of bursts and bruxism episodes per hour, amplitude and duration of bruxism episodes, sleep efficiency and latency, percentage of non-REM and REM sleep, respiratory events, periodic limb movements, and micro-arousals. Conclusions: The polysomnographic characteristics of patients with sleep bruxism, with and without orofacial pain, are similar. More studies are necessary to clarify the reasons why some sleep bruxism patients develop chronic myofascial pain, and others do not. © 2006 Elsevier Ltd. All rights reserved.

Botucatu, Brazil: A Regional Community Palliative Care Model

The Pain Management and Palliative Care Service in the Department of Anesthesia at Botucatu Medical School, UNESP is a pioneer in Brazil. Based on an interdisciplinary team that provides specialized inpatient, ambulatory outpatient, and home care to patients in Botucatu and the surrounding region, the service is also able to provide extensive educational opportunities in pain management and palliative care for medical students, anesthesia residents, practicing anesthetists, and nurses. © 2007 U.S. Cancer Pain Relief Committee.

Métodos de avaliação da eficácia dos tratamentos para a dor.

Pain is a subjective condition and, thus, difficult to measure. The best tools to assess pain are the pain evaluation questionnaires, which provide either diagnostic, pain evolution or pain intensity information. To provide information which could help differentiate between nociceptive pain and neuropathic pain is one of the most important functions of these questionnaires. The questionnaires can measure pain intensity, quality of life, or sleep quality. Quality of life and sleep are two really important characteristics to assess the pain impact on patients' life. Pain intensity assessing questionnaires combine physical evaluations with questions, providing information either from the patient sensations or clinical assessment of pain manifestations as well as the underlying biological mechanisms (such as hyperalgesia or allodynia). For example, the Pain Detect questionnaire has two parts: the patient form (intuitive, with pictures and easy understandable) and the physician form. Thus, in this questionnaire, subjective information is provided by the patient and the objective one is provided by the physician. Other pain intensity questionnaires are NPSI, DN4, LANSS or StEP. Quality of life questionnaires are versatile (can be used in different pathologies). These questionnaires include functional self-evaluation questions, and other ones associated to physical and mental health. Two of such quality of life questionnaires are SF-36 and NHP. Sleep evaluation questionnaires include quantitative features such as the number of sleep interruptions, sleep latency or sleep duration as well as qualitative characteristics such as rest sensation, mood and dreams. One of the most used sleep evaluation questionnaires is PSQI, which includes patient questions and bed-partner questions, providing information from two points of view. Copyright 2009 Prous Science, S.A.U. or its licensors. All rights reserved.

Fisioterapia no tratamento da dor orofacial de pacientes com disfunção temporomandibular crônica

Recent studies have shown consistent results using the physical therapy in cases of pain and limitation of movement from temporomandibular dysfunction. Thus, our objective was to assess the effect of ten sessions of physical therapy and laser therapy in treatment of muscular pain and arthralgias in a woman with temporomandibular dysfunction. The painful symptoms relief achieved by session was over 20 %, up to zero at the end of treatment. Results demonstrated that the treatment protocol used was effective to reduce the temporomandibular joint and the masseter muscle tension and a decreased of drugs by patient. However, more studies are needed to define with more accuracy the effect of other physiotherapy programs and its interaction with other treatment modalities.

Sensibilidade dolorosa à palpação em pacientes con disfunção temporomandibularr crônica

The cephalalgias are frequently associated with the temporomandibular disorders being common to find an increase of pain sensitivity in these patients. Thus, the objective of present study was to assess the sensitivity to palpation in patients presenting with chronic temporomandibular disorders comparing two groups one with headache and other without it, respectively. The temporomandibular disorders and the primary cephalalgias were diagnosed according the Diagnostic Criteria for the Research of Temporomandibular Disorders and by a questionnaire based on the International Classification of the Cephalalgias (2004). Location, assessment and grouping of muscular and articular areas for palpation were carried out according to the Diagnostic Criteria for above mentioned disorders, considering bilaterally the masseter muscle, the temporalis muscle, the cervical region and the temporomandibular joint. Sample included 213 (88.0 %) of women and 29 (12.0 %) men with a mean age of 37.41 years. The mean of number of zones positive to palpation in the groups without headaches, tension headache, migraine and daily chronic headache were: 12.43, 14.38, 15.21 and 15.62 (p= 0.107) (min 2 max 22). The areas of temporalis muscle showed significant differences among groups (p= 0.007). The number of painful points was not statistically different among groups and only in the temporalis muscle there were differences with statistical significant to palpation.

Fatores de risco de desordens osteomusculares presentes no posto de trabalho de estudantes de odontologia

Objective: To identify the perception of undergraduate dental students with respect of the risk factors present at the study/work place that could contribute to the development of musculoskeletal disorders. Method: A total of 348 undergraduate dental students from Araraquara Dental School - UNESP were evaluated. The Portuguese version of the Work-related activities that may contribute to job-related pain and/or injury questionnaire was used. Data were analyzed by descriptive statistics. Results: The mean perception of the undergraduates was 5.68 (SD=1.92). The factors with highest mean values were continue working with some kind of pain or lesion (7.49, SD=2.55), bending or twisting the back in an uncomfortable manner (7.39, SD=2.59), working in uncomfortable/inadequate positions (7.27. SD=2.60) and working in the same position for long periods (7.02. SD=2.53). Overall, female students presented higher mean scores of perception than male students. The body parts with highest prevalence of pain were the neck (67.0%) and lower back (65.8%). Conclusion: The students showed perception in relation to the risk factors for musculoskeletal disorders present at the study/work place.

Musculoskeletal disorders (MSDs) in dancers and former dancers participating in the largest dance festival in the world

Objective: To verify the presence of musculoskeletal disorders (MSD) in dancers and former dancers participating in the 27th Joinville Dance FestivalMaterial and methods: The research was conducted at the 27th Joinville Dance Festival in Santa Catarina, Brazil, with 173 participants in the competition, where 139 were dancers and 34 were former dancers with at least ten years of practiceIn order to obtain information related to MSDs, dancers answered a specific questionnaireResults: The study group consisted of adults (28±9 years) with body mass index within the normal range (21.3±2.3) with high weekly training time (955.7±837.2) and featuring long-time experience in dancing (18±7years)The lumbar spine and knees were the most affected by MSDsThe pain of high intensity was the symptom that most often appeared in reports among survey participantsConclusion: It is important to have deeper knowledge of the prevalence of pain among professional dancers, the factors associated with pain conditions and its impact on everyday life in order to plan new forms of prevention and plan new forms of prevention and treatment within a multidisciplinary approach© 2012 Elsevier Masson SAS.

Endaural access to remove the projectile from a firearm

Background: Surgical approaches to temporomandibular region have been the subject of numerous controversies in the literature. Pre-auricular approaches have been used with the observance of high success rate, and during surgery history, various modifications of this approach were conducted in order to reduce irreversible sequelae. Thus, given the relevance of the study, this article proposes to alert the professionals that carry out these surgical approaches in relation to the anatomical structures involved and to describe and emphasise the benefits of endaural approach. Case report: A Caucasian male patient, victim of a firearm injury, sustained a wound on the right pre-auricular region, and at the time of assessment, he complained of pain, mouth opening difficulty and dysphagia. On physical examination, there was oedema and ecchymosis in the right periorbital region. In the radiological examination, a foreign body compatible with a firearm projectile was observed in the right pre-auricular region, being in accordance with the information collected. The endaural incision and divulsion by plans was then made until the projectile. Discussion: For proper exposure of the region, several studies were designed to evaluate the patterns of branching and anastomosis of the facial nerve. As for the best cosmetic result with the different pre-auricular approaches, the endaural approach was described as an approach that offers great cosmetic results because the incision design guides the surgeon in the wound closure and causes a decrease in the tension of flap, unlike that observed by some authors. © 2012 Springer-Verlag Berlin Heidelberg.

Efeitos do tramadol no modelo de dor induzida por obstrução intestinal em eqüinos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Medição da descarga de peso de indivíduos hemiplégicos e não hemiplégicos utilizando uma nova plataforma de força

Pós-graduação em Engenharia Elétrica - FEIS

Avaliação do efeito do extrato hidroalcóolico de Myrcia bella cambess na dor aguda e na inflamação em modelos experimentais de roedores

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Estudo piloto para avaliar a eficácia do uso de curativo bioativo - cola de fibrina e do curativo convencional em pacientes com câncer portadores de úlcera por pressão

Pós-graduação em Pesquisa e Desenvolvimento (Biotecnologia Médica) - FMB