Lead Poisoning by Intradiscal Firearm Bullet A Case Report

Study Design. The report of a rare case of lead poisoning by an intradiscal firearm bullet is presented. Objective. To describe and discuss the clinical and radiologic features (by computed tomography and magnetic resonance imaging) of a gunshot wound in the L2-L3 space which caused lead poisoning 5 years afterwards. Summary of Background Data. Lead poisoning from firearm bullets is rare, but the possibility should be investigated in the case of bullets lodged in the joints. Methods. A 30-year-old man presented to the emergency room with an intense lumbar pain complaint, colic, intestinal constipation, insomnia, and progressive headache for 20 days. He had a history of a gunshot wound 5 years previously, and the bullet was left in situ, in the intravertebral disc between L2 and L3, as confirmed by radiographs, computed tomography, and magnetic resonance imaging. The hypothesis of lead poisoning was confirmed by the laboratory results. Chelation treatment with calcium versenate (disodium ethylenediaminetetraacetate, or CaNa (2) EDTA) was indicated. The patient was admitted and treated once again, before surgical removal of the bullet. Results. After removal of the bullet, the patient had an episode of recurrence, and a new chelation cycle was performed, with complete resolution. Conclusion. Lead poisoning can result in severe clinical disorders that require rapid treatment. In this case, both clinical and surgical treatments led to complete resolution of the symptoms.

Group psychotherapy: An additional approach to burning mouth syndrome

Introduction: Glossodynia or burning mouth syndrome (BMS) is a common and poorly understood disorder. Its treatment is uncertain. Otherwise, there is some evidence of the importance of psychological factors in the genesis of this disease. Objectives: Verify the usefulness of group psychotherapy as an adjuvant therapeutic method in the treatment of BMS. Casuistics and Methods: The study group consisted of 64 consecutive patients with a clinical diagnosis of BMS seen at the Stomatology Outpatient Clinic, ENT Department, Sao Paulo University Medical School, between May 2002 and May 2007. All the patients were submitted to physical examination, laboratorial screening tests, psychological assessment (Crown-Crisp Experimental Inventory), and answered a short form of the McGill Pain Questionnaire. Only 44 patients who did not show any abnormality in the protocol exams entered the study. Twenty-four of them underwent group psychotherapy. Twenty patients received placebo. Chi-square test was applied to compare the results of treatment with or without psychotherapy. Results: There were 15 men and 29 women in the study group. Tongue burning was the main complaint of the patients. Improvement of symptoms was reported by 17 (70.8%) of the patients undergoing psychotherapy, while among those who did not eight (40%) had improvement of symptoms (P=.04). Conclusion: Psychological assessment demonstrated a close correlation between symptoms and psychological factors, suggesting that group psychotherapy is an important alternative to conventional treatment methods. (C) 2009 Elsevier Inc. All rights reserved.

Gingival juvenile xanthogranuloma in an adult patient: case report with immunohistochemical analysis and literature review

Juvenile xanthogranuloma (JXG) is a non-Langerhans cell histiocytosis (nonLCH). It is a benign and self-healing disorder that generally affects infants and children. Oral lesions in adult patients are rare, although the microscopic findings are similar to those observed in other locations. A 56-year-old white man presented with a chief complaint of a gingival mass that had appeared 6 months before and had grown slowly. An intraoral examination revealed the presence of a solitary, softened gingival mass affecting the mandibular lingual gingiva at the right central incisor area. A biopsy of the lesion showed multiple large macrophages and numerous giant cells of Touton type. The immunohistochemistry positivity for CD68, fascin, factor XIIIa, alpha-antitrypsin and negativity for S-100, beta-actin, CD1a, and desmin confirmed the diagnosis of JXG. The occurrence of adult oral JXG is extremely rare. It is a nonLCH that may present variable clinical and microscopic aspects, which leads to a diversity of clinical misdiagnoses. A precise diagnosis of these lesions requires an accurate evaluation of clinical, microscopic, and immunohistochemical features.

Nocturnal awakening with headache and its relationship with sleep disorders in a population-based sample of adult inhabitants of Sao Paulo City, Brazil

Our aim was to estimate the prevalence of nocturnal awakening with headache (NAH) in the population of Sao Paulo City according to gender, age (20-80 years old) and socioeconomic classes and its relationship to sleep disorders, sleep parameters, anxiety, depression, fatigue, life quality and obesity. We used a population-based survey with a representative three-stage cluster sample. Questionnaires and scales were applied face-to-face, and polysomnography was performed in 1101 volunteers, aged 42 +/- 14 years, 55% women. The complaint of NAH occurring at least once a week had a prevalence of 8.4%, mostly in women, obese subjects and those aged 50-59 years-old. We observed associations of NAH with insomnia, restless leg syndrome (RLS), nightmares and bruxism, but not obstructive sleep apnea syndrome. In a logistics regression model, risk factors for NAH were female gender, odds ratio (OR) (95% confidence interval [CI]) 4.5 (2.8-7.3); obesity, OR 1.9 (1.1-3.3); age between 50 and 59 years, OR 2.4 (1.2-4.7); severe anxiety, OR 8.1 (3.6-18.1); RLS, 2.7 (1.2-5.6); and nightmares, 2.2 (1.3-3.7). Our study shows that NAH was highly prevalent in the population of Sao Paulo and suggests that this phenomenon has specific characteristics with specific risk factors: obesity, RLS and nightmares.

Progressive bilateral enophthalmos associated with cerebrospinal shunting

A 22-year-old woman was examined for a complaint of bilateral progressive enophthalmos that had begun after the cerebrospinal fluid shunting procedure 9 years ago. Photographs and CT scans taken before surgery proved that the position of her eyes was normal before surgery. The enophthalmos was so severe that it induced a poor eyelid-globe apposition with trichiasis and superficial keratopathy. CT of the orbits showed that both orbital roofs were arched and displaced toward the anterior cranial fossa. The placement of porous polyethylene sheets on the orbital roofs through a coronal approach corrected the eye position. A literature review indicated that cerebrospinal shuntings are plagued by a variety of complications including bone changes and craniosynostosis. We believe that enophthalmos associated with cerebrospinal fluid shunting results from a rare acquired bony orbital anomaly.

Orthodontic-surgical treatment of Class III malocclusion with extraction of an impacted canine and multi-segmented maxillary surgery

Establishment of a treatment plan is based on efficacy and easy application by the clinician, and acceptance by the patient. Treatment of adult patients with Class III malocclusion might require orthognathic surgery, especially when the deformity is severe, with a significant impact on facial esthetics. Impacted teeth can remarkably influence treatment planning, which should be precise and concise to allow a reasonably short treatment time with low biologic cost. We report here the case of a 20-year-old man who had a skeletal Class III malocclusion and impaction of the maxillary right canine, leading to remarkable deviation of the maxillary midline; this was his chief complaint. Because of the severely deviated position of the impacted canine, treatment included extraction of the maxillary right canine and left first premolar for midline correction followed by leveling, alignment, correction of compensatory tooth positioning, and orthognathic surgery to correct the skeletal Class III malocclusion because of the severe maxillary deficiency. This treatment approach allowed correction of the maxillary dental midline discrepancy to the midsagittal plane and establishment of good occlusion and optimal esthetics. (Am J Orthod Dentofacial Orthop 2010;137:840-9)

Eruption Cysts in the Neonate

Disturbances of the dental development may result in anomalies, which may be apparent as soon as the child is born. Eruption cysts are rarely observed in neonates considering that at this stage of the child`s life teeth eruption is uncommon. Thus, the aim of this report is to describe a case of eruption cysts in a neonate. A male neonate was brought to the emergency service with the chief complaint of an elevated area on the anterior region of the inferior alveolar ridge. The lesion was clinically characterized as a compressive and floating swelling. Through a radiographic exam two mandibular primary incisors could be seen superficially located. Due to the patient`s age and the initial diagnosis of eruption cysts the conduct adopted was clinical surveillance. Forty-five days after the first visit the lesions had significantly decreased in size, and completely disappeared after 4 months. at that age, both mandibular central incisors were already in the oral cavity exhibiting small hypoplastic areas in the incisal edges. The clinical and radiographic follow-up of eruption cysts in neonates appears to be an adequate conduct without differing from that recommended for older children.

Analyzing the researcher's work in generating data: The case of complaints

This article investigates the researcher's work in the coproduction (or not) of complaint sequences in research interviews. Using a conversation analytic approach, we show how the interviewer's management of complaint sequences in a research setting is consequential for subsequent talk and thus directly affects the data generated. In the examples shown here, researchers sharing cocategorial incumbency with respondents may well provide spaces for research participants to formulate complaints. This article examines sequences of talk surrounding complaints to show how researchers generate complaints (or not) and handle unsafe complaints. Researchers are able to provoke specific types of accounts from respondents, whereas their respondents may actively resist the researchers' direction. For researchers using the interview as a method of data generation, examination of complaint sequences and how these appear in interview data provides insight into how interview talk is coproduced and managed within a socially situated setting.

Prevalence of periodontal disease in dogs and owners' level of awareness - a prospective clinical trial

Periodontal disease (PD) is widely known among veterinarians for its high prevalence and serious consequences to the dogs. The objective of this study was to assess the occurrence of PD in dogs that live in the micro-region of Viçosa, treated at the Veterinary Hospital of the Federal University of Viçosa (HVT - Hospital Veterinário da Universidade Federal de Viçosa), as well as to assess how aware of this disease dog owners are. In order to do so, all dogs treated at the HVT from March 10th, 2009 to November 30th, 2009, on alternate days, had their oral cavities examined. Medical history data, such as age, type of food, main complaint and owner consent, halitosis, presence of dental calculus, inflammation and gingival recession and tooth loss, were collected. A prevalence of 88.67% was found for PD in dogs referred to the HVT, and 2.67% were referred due to this disease. Of all the owners who participated in the study, 43.83% knew about periodontal disease and of these 17.46% made use of some type of prevention or treatment. Therefore, periodontal disease is highly prevalent and the owners are not aware of the disease. Thus, a dog owner clarification program on periodontal disease is needed in the area where HVT-UFV operates.

INFIDELIDADE: um crime de gestão contra o património

Diz o art. 224º do Código Penal português (CP): “1 - Quem, tendo-lhe sido confiado, por lei ou por acto jurídico, o encargo de dispor de interesses patrimoniais alheios ou de os administrar ou fiscalizar, causar a esses interesses, intencionalmente e com grave violação dos deveres que lhe incumbem, prejuízo patrimonial importante é punido com pena de prisão até 3 anos ou com pena de multa. § 2 - A tentativa é punível. § 3 - O procedimento criminal depende de queixa. § 4 – É correspondentemente aplicável o disposto nos n.os 2 e 3 do artigo 206.º e na alínea a) do n.º 1 do artigo 207º. Redacção da Lei nº 19/2013, de 21/2 – vigente a partir de 23/3/13. Referem, por um lado, os n.os 2 e 3 do artigo 206º: “Restituição ou reparação: (…) 2 - Quando a coisa furtada ou ilegitimamente apropriada for restituída, ou tiver lugar a reparação integral do prejuízo causado, sem dano ilegítimo de terceiro, até ao início da audiência de julgamento em 1ª instância, a pena é especialmente atenuada. § 3 - Se a restituição ou a reparação forem parciais, a pena pode ser especialmente atenuada”. § Says the art. 224 of the Portuguese Penal Code (PC): "1 - Who, having been entrusted by law or legal act, the disposal charge of other people's property interests or to manage or supervise, cause to those interests, intentionally and with serious breach of his duties, important material damage is punished with imprisonment up to three years or a fine. § 2 - The attempt is punishable. § 3 - The criminal proceedings on a complaint. § 4 - It is accordingly applicable the provisions of paragraphs 2 and 3 of Article 206 and paragraph a) of paragraph 1 of Article 207. Wording of Law No. 19/2013, of 21/2 - effective from 03.23.13. Refer on the one hand, paragraphs 2 and 3 of Article 206: "Restitution or repair: (...) 2 - When the stolen or illegally appropriate thing is restored, or have rise to full compensation for financial loss, no illegitimate damage Third, until the beginning of the trial, in 1st instance, the penalty is mitigated. § 3 - If the refund or repair are partial, the penalty can be mitigated. "

Agressividade e índice de Apgar

A agressividade é o comportamento que surge transversalmente como queixa isolada ou a par de outras queixas na maioria das crianças com e sem doença, que procuram apoio em saúde mental infantil. Nessas crianças, e a partir da recolha dos dados anamnesicos, tem-se verificado a constância de registo, no Livro do Bebé, de Índice de Apgar ≤ 9 ao primeiro minuto. Este estudo exploratório pretendeu analisar a hipótese teórica de que o Índice de Apgar abaixo de 10 ao primeiro minuto pode ser representativo de sofrimento fetal intraparto ou perinatal e assim fragilizar os circuitos neuronais das emoções tendo como consequência o surgimento, ao longo do desenvolvimento infantil e juvenil, de dificuldades na capacidade de gestão ou controlo das emoções, com comportamentos opositivos e/ou agressivos, como resposta defensiva de luta e fuga. Utilizou-se uma amostra de crianças inscritas no serviço de consulta externa de saúde mental infantil e juvenil, e verificou-se se as queixas de perturbação do comportamento com agressividade, formuladas no momento do acolhimento ao serviço, estão relacionadas com o Índice de Apgar ≤ 9 ao primeiro minuto e/ou com os registos de sofrimento fetal. Procurou-se, numa amostra aleatória de crianças sem queixa formulada no serviço de consulta externa de saúde mental infantil e juvenil, perceber as diferenças ou semelhanças dos registos de nascimento relativamente à amostra de crianças inscritas. Foi ainda auscultada a opinião dos profissionais dos serviços de obstetrícia e neonatologia – pediatria, mediante a aplicação de um questionário, no sentido de recolher as opiniões dos profissionais de saúde que lidam com o parto, que avaliam o Índice de Apgar dos recém – nascidos e que os seguem durante as primeiras horas ou dias de vida. Das conclusões a que chegamos, salienta-se que o sofrimento fetal intraparto pode ser predictor de dificuldades de controlo emocional traduzidas em alterações do comportamento com agressividade em situações de stress. Não se conclui que o Índice de Apgar ≤ 9 pode ser predictor de alterações do comportamento com agressividade em situações de stress, uma vez que os registos de ocorrências de sofrimento fetal intraparto e os registos do Índice de Apgar ao primeiro minuto são, na amostra de crianças com queixa, díspares, relacionando-se no entanto de modo estatisticamente significativo na amostra de crianças sem queixa. III No entanto, e apesar das dificuldades metodológicas, fica a certeza de haver mais percursos a percorrer nesta direcção para a compreensão dos distúrbios emocionais e a agressividade.

Intervenção com procedimentos de autossugestão na autoeficácia e controlo da dor

Introdução – A dor predomina em muitas patologias médicas e acarreta diversas implicações para o doente. O presente estudo visou avaliar a eficácia de uma intervenção autossugestiva, como complemento ao tratamento médico, no aumento da autoeficácia e controlo da dor. Metodologia – Para a concretização deste objetivo, 205 pacientes adultos com dor foram distribuídos aleatoriamente por dois grupos que se distinguiram quanto à intervenção recebida durante 12 semanas, nomeadamente IAS (intervenção autossugestiva) e ISAS (intervenção sem autossugestão). Os dois grupos foram comparados quanto à evolução da autoeficácia e do controlo da dor ao longo desse período. Resultados e discussão – Os resultados mostraram um aumento estatisticamente significativo destas variáveis no grupo IAS mas não no grupo ISAS, sugerindo a eficácia da intervenção autossugestiva. Este estudo representa, assim, um importante contributo para a prática clínica com os doentes com dor.

Efectividade da terapia manual ortopédica num caso de conflito subacromial – Estudo de caso

Objectivo: descrever a intervenção em fisioterapia num paciente com diagnóstico de conflito subacromial. Participantes e Métodos: estudo de caso de um paciente que desenvolveu um quadro doloroso no ombro direito no início de Janeiro de 2011 e em que a intervenção de fisioterapia teve início no princípio de Março de 2011. Foi utilizado como instrumentos de avaliação a EVA (repou-so, noite, e movimentos activos), a escala DASH, goniometria e raio x. Foi aplicado uma variedade de técnicas musculares, nomeadamente técnicas de indução miofasciais, exercícios terapêuticos, kinesiotape, bem como articulares, como a mobilização com movimento de Mulligan. O tratamento foi realizado em dias alternados e teve a duração total de seis semanas. Resultados: logo no final da primeira sessão o paciente referiu melhoria na dor e movimentos activos. Na segunda sessão o paci-ente demonstrou capacidade de realizar auto-mobilização, exercícios terapêuticos e alongamentos no domicílio. A regressão dos sintomas foi relativamente rápida, apenas na quarta sessão não obte-ve melhorias na reavaliação, até à completa remissão no fim da nona sessão. Conclusão: o processo de raciocínio clínico desenvolvido pelo fisioterapeuta durante de tratamento foi salientado. Após a recolha dos dados relativos à história e sua interpretação levantaram-se hipóteses o qual poderia estar na origem numa queixa do ombro com estas características. No exame objectivo foram reali-zados testes para permitir a obtenção do diagnóstico diferencial – conflito subacromial; elaborou-se então um plano de intervenção em colaboração com o paciente, nomeadamente com técnicas de terapia manual recentes, que se mostrou eficaz, com excelentes resultados.

Caracterização do fibro edema gelóide e respectivos tratamentos nos estudantes de fisioterapia

Mestrado em Fisioterapia

Cerebrospinal fluid profiles in acquired immunodeficiency syndrome with and without neurocryptococcosis

Cryptococcosis is one of the most common fungal infections of the central nervous system (CNS) in AIDS patients and meningoencephalitis or meningitis is a frequently observed manifestation. However, systematic studies of cerebrospinal fluid (CSF) composition from AIDS patients with CNS cryptococcosis have been few. CSF samples from 114 HIV seropositive patients whose clinical complaint suggested CNS involvement, were analyzed; 32 samples from patients diagnosed as having neurocryptococcosis (Group 1) and 82 samples from patients with no identified neurological disfunction (Group 2). Based on cytological and biochemical results, two distinct profiles were observed: Normal (Group 1 = 31%, Group 2 = 39%); Abnormal (Group 1 = 69%, Group 2 = 61%). Lymphocytes were the most frequent cells in both groups. Our CSF cytological and biochemical findings showed that in AIDS patients liquoric abnormalities are quite frequent, non-specific and difficult to interpret. In these circumstances a systematic search to identify the etiologic agent using microbiological and/or immunological assays must be routinely performed