Evaluación funcional de pacientes con osteoartritis que asistieron al Centro de Rehabilitación Integral Especializado Guayaquil / Functional evaluation of patients with osteoarthritis who attended the Guayaquil Specialized Comprehensive Rehabilitation Center / Avaliação funcional de pacientes com osteoartrite atendidos no Centro Especializado de Reabilitação Integral de Guayaquil

La osteoartritis pertenece al grupo de afecciones articulares degenerativa más común y una de las principales causas de discapacidad en el mundo, caracterizada por provocar dolor articular, rigidez, y pérdida de la capacidad funcional. Objetivo. Evaluar la funcionalidad de los pacientes con osteoartritis que asistieron al Centro de Rehabilitación Integral Especializado Guayaquil # 2. Materiales y Métodos. Se realizó un estudio bajo un enfoque cuantitativo, con un alcance descriptivo y de corte transversal, se desarrolló mediante la medición numérica y análisis de datos de las variables en estudio como edad; sexo; patología; ocupación laboral; rigidez y capacidad funcional, mediante opciones de respuestas. La recolección de datos se ejecutó por medio de la técnica de la observación, para el análisis de los resultados obtenidos del Cuestionario Western Ontario and McMasters Universities Osteoarthritis Índex. Resultados. Se determinó que de acuerdo al sexo prevaleció el femenino en un 90%, la mayoría entre 60 y 70 años de edad; el 70% del grupo estudiado fueron las amas de casa; patología frecuente la poliosteoartritis en un 85%; presentaron un 55% muchísimo dolor y el 45% mucho dolor; la rigidez en un 45%; mientras un 10% no disminución de la capacidad funcional en las articulaciones afectadas. Conclusiones. La osteoartritis afectó la condición funcional a la mayoría de las mujeres y se evidenció con el análisis de la evaluación del resultado obtenido, mediante el Cuestionario Womac.

Osteoarthritis belongs to the most common group of degenerative joint conditions and is one of the leading causes of disability in the world, characterized by joint pain, stiffness, and loss of functional capacity. Objective. To evaluate the functionality of patients with osteoarthritis who attended the Centro de Rehabilitación Integral Especializado Guayaquil # 2. Materials and Methods. A study was carried out under a quantitative approach, with a descriptive and cross-sectional scope, developed through numerical measurement and data analysis of the variables under study such as age; sex; pathology; work occupation; stiffness and functional capacity, by means of response options. Data collection was carried out by means of the observation technique, for the analysis of the results obtained from the Western Ontario and McMasters Universities Osteoarthritis Index Questionnaire. Results. It was determined that according to sex, 90% were female, most of them between 60 and 70 years of age; 70% of the group studied were housewives; 85% had polyosteoarthritis; 55% had a lot of pain and 45% a lot of pain; 45% had stiffness; while 10% had no decrease in the functional capacity of the affected joints. Conclusions. Osteoarthritis affected the functional condition of most of the women and this was evidenced by the analysis of the evaluation of the result obtained by means of the Womac Questionnaire.

A osteoartrite pertence ao grupo mais comum de condições articulares degenerativas e é uma das principais causas de incapacidade no mundo, caracterizada pela dor articular, rigidez e perda da capacidade funcional. Objetivo. Avaliar a funcionalidade dos pacientes com osteoartrite que atendem ao Centro de Reabilitação Integral Especializado Guayaquil # 2. Materiais e métodos. Foi realizado um estudo sob uma abordagem quantitativa, com um escopo descritivo e transversal, desenvolvido por meio de medição numérica e análise de dados das variáveis em estudo, tais como idade; sexo; patologia; ocupação do trabalho; rigidez e capacidade funcional, por meio de opções de resposta. A coleta de dados foi realizada por meio da técnica de observação, para a análise dos resultados obtidos das Universidades Western Ontario e McMasters Questionário do Índice de Osteoartrite. Resultados. Foi determinado que, segundo o sexo, 90% eram do sexo feminino, a maioria entre 60 e 70 anos de idade; 70% do grupo estudado eram donas de casa; 85% tinham polioseartrose; 55% tinham muita dor e 45% muita dor; 45% tinham rigidez; enquanto 10% não tinham diminuição da capacidade funcional das articulações afetadas. Conclusões. A osteoartrose afetou a condição funcional da maioria das mulheres e foi evidenciada pela análise da avaliação do resultado obtido por meio do Questionário Womac.

Depressive symptoms and axial motor disorders in individuals with Parkinson's disease: a cross-sectional study / Sintomas depressivos e distúrbios motores axiais em indivíduos com doença de Parkinson: um estudo transversal

Abstract Background Depression is an important nonmotor symptom of Parkinson's disease (PD) and has been associated with the motor symptoms in these individuals. Objectives To determine whether there are relationships between depressive symptoms and abnormalities in axial postural alignment and axial motor deficits, especially postural instability, and trunk rigidity in PD. Methods In this cross-sectional study, 65 individuals were evaluated using the Beck Depression Inventory-II (BDI-II) for the analysis of depressive symptoms and underwent a postural assessment of head, trunk, and hip sagittal alignment through computerized photogrammetry. The MDS-UPDRS was used to assess clinical aspects of PD, the Trunk Mobility Scale was used to assess axial rigidity, and the MiniBESTest to assess balance. To determine the relationship between depressive symptoms and postural alignment, multiple linear regression analysis was performed. Results The participants with depressive symptoms had more severe motor deficits as well as greater trunk rigidity and worse postural instability (p < 0.05). When the postural angles were compared between men and women using Student's t-test, it was found that men had greater flexion angles of the head (p = 0.003) and trunk (p = 0.017). Using multiple linear regression analysis corrected for the age and sex of the participants, we verified that the anterior trunk inclination was significantly larger in the PD population with depressive symptoms (R2 = 0.453, β = 0.116, and p = 0.045). Conclusion PD individuals with depressive symptoms have more severe flexed trunk posture, mainly in older men. Additionally, more severe depressive symptoms are associated with worsening postural instability, trunk rigidity and motor deficits in this population.

Resumo Antecedentes A depressão é um sintoma não motor importante da doença de Parkinson (DP) e tem sido associada aos sintomas motores nesses indivíduos. Objetivos Determinar se existem relações entre sintomas depressivos e anormalidades no alinhamento postural axial e déficits motores axiais, especialmente instabilidade postural e rigidez de tronco na DP. Métodos Neste estudo transversal, 65 indivíduos foram avaliados pelo BDI-II para análise de sintomas depressivos e submetidos à avaliação postural do alinhamento sagital de cabeça, tronco e quadril por meio de fotogrametria computadorizada. A MDS-UPDRS avaliou os aspectos clínicos, TMS avaliou rigidez axial e o MiniBESTest equilíbrio. Para determinar a relação entre sintomas depressivos e alinhamento postural, realizou-se uma análise de regressão linear múltipla. Resultados Os participantes com sintomas depressivos apresentaram déficits motores mais graves, bem como maior rigidez de tronco e pior instabilidade postural (p < 0,05). Quando comparados os ângulos posturais entre homens e mulheres pelo teste t de Student, verificou-se que os homens apresentaram maiores graus de flexão da cabeça (p = 0,003) e do tronco (p = 0,017). Por meio da análise de regressão linear múltipla corrigida para a idade e sexo dos participantes, verificamos que a inclinação anterior do tronco foi significativamente maior nos indivíduos com DP com sintomas depressivos do que sem sintomas depressivos (R2 = 0,453, β = 0,116 e p = 0,045) Conclusão Indivíduos com DP com sintomas depressivos apresentam postura de tronco flexionado mais severa, principalmente em homens mais idosos. Além disso, os sintomas depressivos mais graves pioram significativamente a instabilidade postural, a rigidez do tronco e os déficits motores nessa população.

Clinical, skeletal muscle pathological and genetic characteristics of fatal infantile hypertonic myofibrillar myopathy / 中华实用儿科临床杂志

Objective:To investigate the clinical, skeletal muscle pathological, and genetic characteristics of fatal infantile hypertonic myofibrillar myopathy (FIHMM).Methods:The clinical manifestations, laboratory assessments data and gene sequencing results of 10 patients diagnosed with FIHMM in Shenzhen Children′s Hospital from February 2017 to April 2021 were retrospectively analyzed.Magnetic resonance imaging (MRI) of both musculoskeletal system and the brain, and electromyogram (EMG) were performed in 3 cases, while muscle biopsy was performed in 2 cases.Results:Among these 10 cases, 1 case was from Northeast China and 1 case from East China, while the rest 8 cases were from South China.Eight of the 10 patients were male, and the other 2 cases were female.They were all born normal and not related to each other.The age of onset varied from 2 to 12 months.The main clinical manifestations for all the patients were progressive rigidity of the rectus abdominis (8 cases), neck muscles (7 cases), rectus abdominis (2 cases) and intercostal muscles (1 case), resulting in respiratory failure.Mildly to moderately elevated serum creatine kinase level was detected (436-5 804 IU/L) (reference range: 24-229 IU/L). Complex repetitive discharges can be seen in the EMG, without any myotonic potential.Muscle fiber degeneration, necrosis, and vacuolar degeneration were noted in the histopathological examination of the vastus lateralis and rectus abdominis.An abnormal red granular deposit was observed in a portion of the field of the modified Gomory Trichrome staining.Immunohistochemistry showed substantial deposition of desmin.Under the electron microscopy, the sarcomere structure of the muscle fibers was seriously disordered, with the destruction of Z-bands and the presence of granular deposits.The whole-exome sequencing identified the same homozygous variation c. 3G>A, p.Met1? of CRYAB gene in all the patients, but heterozygous variation in their parents. Conclusions:Axial muscles involvement, such as rectus abdominis rigidity, is the main clinical characteristic of FIHMM.c.3G>A, p.Met1? mutation in the CRYAB gene is a hotspot mutation in Chinese children.

Changes in the flexor and extensor muscles at different speeds / Mudanças nos músculos flexor e extensor a diferentes velocidades / Cambios en los músculos flexor y extensor a diferentes velocidades

ABSTRACT Introduction: Centrifugal strength is an important element for strength quality. Developing muscle centrifugal strength can effectively increase the stability of lower limbs and reduce the risk of injury. Objective: To explore the characteristics of contractile force of flexor ahods in strength training and rehabilitation training, and the extensor muscles of the knee joint in athletes with different speeds of centripetal force. Methods: The knee joint muscle group of 8 first-level male high jumpers and 8 second-level male high jumpers were tested by isokinetic centrifugal contraction; the angular test velocity was 60 °/s, 120 °/s, 240 °/s, and the indexes included peak torque, relative peak torque (peak torque/body weight), and the peak torque flexural extension ratio. Results: With the centrifugal contraction of the knee joint muscle group (P < 0.05), the second-level high jumpers should increase the ability of the knee flexor muscle group of the take-off leg. In the case of constant velocity centrifugal contraction (P < 0.01), taking off time must be reduced, that is, taking off speed must be accelerated. Conclusions: The difference in the knee joint muscle isokinetic test results is one of the reasons for the difference in knee joint flexor and extensor muscle contractility under the different speed forces of high jumpers. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: A força centrífuga é um elemento importante na qualidade de força. O desenvolvimento da força centrífuga muscular pode, efetivamente, aumentar a estabilidade dos membros inferiores e reduzir o risco de lesões. Objetivo: Explorar as características da força contrátil do músculo flexor no treinamento de força e de reabilitação, e os músculos extensores da junta do joelho em atletas com diferentes velocidades de força centrípeta. Métodos: O grupo muscular da articulação do joelho de oito saltadores de primeiro escalão do sexo masculino, e oito saltadores de segundo escalão do sexo masculino foi testado por contração centrífuga isocinética. A velocidade de teste angular foi de 60 °/s, 120 °/s, 240 °/s, e os índices incluíram torque de pico, torque de pico relativo (torque de pico/peso corporal) e a razão extensão-flexão de torque de pico. Resultados: Na contração centrífuga do grupo muscular da articulação do joelho (P < 0,05), os saltadores de segundo escalão devem aumentar a habilidade do grupo muscular flexor do joelho da perna de arranque. No caso da contração centrífuga de velocidade constante (P < 0,01), o tempo de arranque deve ser reduzido, ou seja, a velocidade de arranque deve ser acelerada. Conclusões: A diferença nos resultados dos testes isocinéticos do músculo da junta do joelho é uma das razões para a diferença na contratilidade muscular flexor e extensor da junta do joelho sob forças de velocidade diferentes em saltadores. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

Resumen Introducción: La fuerza centrífuga es un elemento importante en la calidad de fuerza. El desarrollo de la fuerza centrífuga muscular puede efectivamente aumentar la estabilidad de los miembros inferiores y reducir el riesgo de lesiones. Objetivo: Explorar las características de la fuerza contráctil del músculo flexor en el entrenamiento de fuerza y de rehabilitación, y los músculos extensores de la articulación de la rodilla en atletas con diferentes velocidades de fuerza centrípeta. Métodos: Se testó el grupo muscular de la articulación de la rodilla de 8 saltadores de primer escalafón del sexo masculino, y 8 saltadores de segundo escalafón del sexo masculino por contracción centrífuga isocinética. La velocidad de prueba angular fue de 60 °/s, 120 °/s, 240 °/s, y los índices incluyeron torque de pico, torque de pico relativo (torque de pico/peso corporal) y la razón extensión-flexión de torque de pico. Resultados: En la contracción centrífuga del grupo muscular de la articulación de la rodilla (P<0,05), los saltadores de segundo escalafón deben aumentar la habilidad del grupo muscular flexor de la rodilla de la pierna de arrancada. En el caso de la contracción centrífuga de velocidad constante (P<0,01), el tiempo de arrancada debe reducirse, o sea, la velocidad de arrancada debe acelerar. Conclusiones: La diferencia en los resultados de las pruebas isocinéticas del músculo de la articulación de la rodilla es una de las razones para la diferencia en la contractilidad muscular flexor y extensor de la articulación de la rodilla bajo fuerzas de velocidad diferentes en saltadores. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

Luxaciones puras de codo en pacientes pediátricos: tratamiento conservador y complicaciones asociadas a una patología poco prevalente. Serie de 4 casos / Isolated elbow dislocation in pediatric patients: non-operative treatment and complications associated with an infrequent pathology. Series of 4 cases

Si bien el codo es la articulación más frecuentemente luxada en niños, representa el 3-6 % de las lesiones en ese sitio. Las luxaciones sin fracturas asociadas son muy raras y son producto de una caída con el codo en extensión. El paciente consulta por dolor, impotencia funcional y deformidad evidente. La finalidad del tratamiento es restaurar la congruencia articular, lograr estabilidad y minimizar los riesgos de posibles lesiones neurovasculares.Se presentan 4 pacientes tratados con manejo conservador con excelentes resultados funcionales, incluso aquel que presentó una neuropraxia del mediano con restitución ad integrum.Según nuestra experiencia, suelen ser lesiones con buena evolución. Se destaca la importancia de un rápido y preciso examen neurovascular, optando, de ser posible, por una conducta expectante ante las lesiones nerviosas. Se resalta la indicación de una inmovilización acotada con movilización temprana que evite rigidez del codo.

Even though the elbow is the most often dislocated joint in children, this injury accounts for 3-6 % of elbow pathology. Dislocations without associated fractures are extremely rare. They result from a fall onto an outstretched hand. The patient is always referred with a painful joint, movement impairment and even clinical deformity. Acute treatment aims to achieve quick reduction and adequate joint stability, avoiding neurovascular injuries.We sought to analyze the functional outcomes and the complications after non-operative treatment. Our 4 patien had excellent functional results at the latest follow-up, and one of them suffered from a median nerve palsy without further consequences.In our experience, these injuries presented excellent outcomes and we would like to highlight the importance of a quick and precise neurovascular examination with the possibility of non-surgical management of nerve injuries. A short period of immobilization with early rehabilitation should be indicated to avoid joint stiffness

Sociodemographic profile and stages of Parkinson's disease associated with predictors of Temporomandibular Disorder / Perfil sociodemográfico e estágios da doença de Parkinson associados com os preditores de disfunção temporomandibular

ABSTRACT Purpose: to analyze the predictors of temporomandibular disorder in people with Parkinson's disease, verifying their associations with sociodemographic aspects and stages of the disease. Methods: a study based on secondary data from research conducted in 2017 with 110 people with Parkinson's disease. They were assessed with the Research Diagnostic Criteria for Temporomandibular Disorders and the Parkinson's disease staging scale. The studied predictive variables for temporomandibular disorder were pain, crepitation, clicking, nighttime and daytime clenching/gnashing, uncomfortable/non-habitual bite, morning rigidity, and tinnitus. The sociodemographic aspects assessed were age, sex, schooling level, marital status, income, and stages 1 to 3 of the disease. The chi-squared odds ratio was used with a 95% confidence interval and significance level at p < 0.05. Results: an association was verified between nighttime clenching/gnashing and income (p = 0.006); tinnitus and income range from ½ to 3 (p = 0.003) and from 4 to 10 minimum wages (p = 0.004); and between tinnitus and stage 1 (p = 0.02). Conclusion: this study verified that the predictors associated with temporomandibular disorder in people with Parkinson's disease were pain, clicking, crepitation, uncomfortable/non-habitual bite, and morning rigidity. It was verified that income and stage 1 of the disease had an association with nighttime clenching/gnashing and tinnitus.

RESUMO Objetivo: analisar os preditores de disfunção temporomandibular em pessoas com doença de Parkinson (DP) verificando suas associações com aspectos sociodemográficos e estágios da doença. Métodos: estudo que utilizou fonte de dados secundários de uma pesquisa realizada em 2017, com 110 pessoas com DP que foram avaliadas pelo questionário para Pesquisa em Disfunção Temporomandibular (RDC/TMD) e pela escala de estadiamento da DP. As variáveis preditoras de DTM estudadas foram: dor, crepitação, estalido, apertamento/rangido noturno e diurno, mordida desconfortável/não habitual, rigidez matinal e zumbido. Os aspectos sociodemográficos avaliados foram: idade, sexo, escolaridade, estado civil, renda e estágios da doença de 1 a 3. Utilizou-se o Odds ratio do Qui-quadrado com intervalo de confiança de 95% e nível de significância de p<0,05. Resultados: verificou-se associação entre os preditores: apertamento/rangido noturno e renda (p=0,006); zumbido e grupos de renda ½ a 3 (p=0,003) e de 4 a 10 salários mínimos (p=0,004). Além da associação do zumbido e estágio 1 (p=0,02). Conclusão: nesse estudo verificou-se que os preditores associados com a DTM em pessoas com DP foram: dor, estalido, crepitação, mordida desconfortável/não habitual e rigidez matinal. E destes verificou-se associação entre renda e estágio 1 da doença com apertamento/rangido noturno e zumbido.

Clinical efficiency and activity range of stiff knee by total knee arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To observe clinical effect and influencing factor of total knee arthroplasty (TKA) for the treatment of stiff knee.</p><p><b>METHODS</b>From January 2010 to October 2014, 20 patients(25 knees) with stiff knee were treated with TKA. Among them, including 2 males(3 knees) and 18 females(22 knees), aged from 55 to 78 years old with an average of(64.5± 4.9) years old, the courses of disease ranged from 5 to 21 years with an average 8.3 years. Preoperative and postoperative HSS (hospital for special surgery knee score) score, activity range and complications were observed and compared.</p><p><b>RESULTS</b>All patients were followed up from 12 to 69 months with an average of 35.3 months. Ten patients occurred complications after operation. HSS score was improved from 32.36±12.31 preoperatively to 80.70±18.52 postoperatively, and had statistical difference between two groups;7 knees obtained excellent results, 15 knees good and 3 knees moderate. Activity range was improved from(39.4±5.3)°preoperatively to (92.5±11.2)° at the latest follow up.</p><p><b>CONCLUSIONS</b>Total knee arthroplasty for stiffness knees is feasible and could obtain satisfied activity range and function.</p>

Analysis on the effect of surgical cleaning combined with external fixator for the treatment of post-traumatic heterotopic ossification of elbow joint / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of surgical treatment using a combined medial and lateral approach combined with an external fixator for the treatment of post-traumatic heterotopic ossification(HO) in patients with stiff elbow joints.</p><p><b>METHODS</b>Surgical release using the combined medial and lateral approach combined with external fixation for the treatment of HO and elbow stiffness in 26 patients from July 2010 to December 2013. The study group included 18 males and 8 females, with an average age 38.7 years (ranged 14 to 60 years). The time from injury to surgery averaged 9.3 (ranged 7 to 18) months. Before and after operation, the elbow range of motion and forearm rotation angle were measured, and the Mayo Elbow Performance Score (MEPS) was evaluated.</p><p><b>RESULTS</b>The wound of all patients was well healed during the first period, except one patient who had chronic infection at the external fixation pin 3 weeks after operation. Then the external fixator was removed. All 26 patients were followed up, and the during ranged from 24 to 40 months, with an average of 34 months. HO recurrence occurred in 1 patient 8 months after operation. The range of motion, forearm rotation angle, and Mayo Elbow Performance Score of elbow joint in patients was significantly improved compared with that before surgery(<0.05).</p><p><b>CONCLUSIONS</b>Surgical release using the combined medial and lateral approach combined with an external fixator for the treatment of traumatic HO and elbow stiffness can effectively improve elbow function, resulting in a satisfactory effect.</p>

Recurrent Desaturation Events due to Opioid-Induced Chest Wall Rigidity after Low Dose Fentanyl Administration / 대한구급학회지

Opioid-induced chest wall rigidity is an uncommon complication of opioids. Because of this, it is often difficult to make a differential diagnosis in a mechanically ventilated patient who experiences increased airway pressure and difficulty with ventilation. A 76-year-old female patient was admitted to the intensive care unit (ICU) after surgery for periprosthetic fracture of the femur neck. On completion of the surgery, airway pressure was increased, and oxygen saturation fell below 95% after a bolus dose of fentanyl. After ICU admission, the same event recurred. Manual ventilation was immediately started, and a muscle relaxant relieved the symptoms. There was no sign or symptom suggesting airway obstruction or asthma on physical examination. Early recognition and treatment should be made in a mechanically ventilated patient experiencing increased airway pressure in order to prevent further deterioration.

Recurrent Desaturation Events due to Opioid-Induced Chest Wall Rigidity after Low Dose Fentanyl Administration / 대한중환자의학회지

Opioid-induced chest wall rigidity is an uncommon complication of opioids. Because of this, it is often difficult to make a differential diagnosis in a mechanically ventilated patient who experiences increased airway pressure and difficulty with ventilation. A 76-year-old female patient was admitted to the intensive care unit (ICU) after surgery for periprosthetic fracture of the femur neck. On completion of the surgery, airway pressure was increased, and oxygen saturation fell below 95% after a bolus dose of fentanyl. After ICU admission, the same event recurred. Manual ventilation was immediately started, and a muscle relaxant relieved the symptoms. There was no sign or symptom suggesting airway obstruction or asthma on physical examination. Early recognition and treatment should be made in a mechanically ventilated patient experiencing increased airway pressure in order to prevent further deterioration.

Estudo do efeito agudo da fadiga na força de membros inferiores durante saltos com contramovimento / Estudio del efecto de la fatiga aguda en la fuerza del miembros inferiores durante saltos con contramovimiento / Acute fatigue effects on ground reaction force of lower limbs during countermovement jumps

Parameters associated with the performance of countermovement jumps were identified from vertical ground reaction force recordings during fatigue and resting conditions. Fourteen variables were defined, dividing the vertical ground reaction force into negative and positive external working times and times in which the vertical ground reaction force values were lower and higher than the participant's body weight. We attempted to explain parameter variations by considering the relationship between the set of contractile and elastic components of the lower limbs. We determined that jumping performance is based on impulsion optimization and not on instantaneous ground reaction force value: the time in which the ground reaction force was lower than the body weight, and negative external work time was lower under fatigue. The results suggest that, during fatigue, there is less contribution from elastic energy and from overall active state. However, the participation of contractile elements could partially compensate for the worsening of jumping performance.

Parâmetros associados com o desempenho do salto contramovimento foram identificados a partir de registros da força vertical em condições de fadiga e não fadiga. Quatorze variáveis foram definidas dividindo a força de reação vertical do solo em valores negativos e positivos de trabalho externo e o tempo em que os valores de força vertical foi menor e maior do que o peso corporal do indivíduo. As variações dos parâmetros foram avaliadas considerando a relação entre conjunto de elementos contráteis e elásticos nos membros inferiores. Determinou-se que o desempenho é baseado na otimização do impulso e não em um valor instantâneo da força; o tempo em que a força de reação do solo foi menor do que o peso corporal e o tempo de trabalho externo negativo são mais baixos sob fadiga. Os resultados sugerem que durante a fadiga há uma menor contribuição da energia elástica e do estado ativo de forma global, mas a participação de elementos contráteis poderia compensar parcialmente a queda de desempenho.

Se identificaron parámetros asociados con el desempeño de saltos con contramovimiento a partir de registros de fuerza vertical en condiciones de fatiga y no fatiga. Catorce variables fueron definidas dividiendo la componente vertical de la curva de fuerza de reacción del suelo en valores negativos y positivos de trabajo externo y tiempo en que los valores de fuerza resultaron menores o mayores que el valor del peso del individuo. Las variaciones de los parámetros fueron evaluadas considerando la relación entre el conjunto de elementos contráctiles y elásticos en los miembros inferiores. Se determinó que el desempeño está basado en la optimización del impulso y no en un valor instantáneo de fuerza; el tiempo en que la fuerza de reacción del suelo fue menor que el peso corporal y el tiempo de trabajo externo negativo resultaron más bajos en fatiga. Los resultados sugieren que durante la fatiga hay una menor contribución de la energía elástica y del estado activo de forma global, pero la participación de elementos contráctiles podría compensar parcialmente la caída en el desempeño.

Atypical neuroleptic malignant syndrome. “Doing more harm than gain”.

Neuroleptic malignant syndrome (NMS) a rare, idiosyncratic, and potentially fatal adverse reaction can be deceptive especially when the hallmark features are lacking. Most diagnostic criteria include fever and muscle rigidity, although NMS may present without either. Delirium, agitation and catatonia can be the earliest features of NMS and in acute care settings, concomitant use of sedatives and anti-psychotics by the attending clinicians may even obscure the sentinel signs of NMS and further aggravate the underlying insult. A strong clinical suspicion based on clinical history is crucial for early diagnosis and treatment and the strict adherence to the classical criteria of NMS may lead to a diagnostic delay and dire consequences for these patients and sometimes this delay can procure death.

Análise histomorfométrica do músculo sóleo de ratos submetidos ao modelo animal de parkinsonismo induzido pelo MPTP / Histomorphometrical analysis of rats' soleus muscle submitted to animal model of MPTP-induced parkinsonism

INTRODUÇÃO: Modelos experimentais da Doença de Parkinson (DP) que reproduzem a desnervação dopaminérgica têm sido desenvolvidos para estudar a patofisiologia desta doença e analisar a eficácia de novas terapêuticas. Dentre os sinais cardinais da DP temos a rigidez muscular, estudos sugerem que mudanças intrínsecas nas propriedades mecânicas do músculo podem ser responsáveis pelo aumento dessa alteração tônica. OBJETIVO: Analisar a morfologia geral e a histomorfometria do músculo sóleo de ratos Wistar induzidos ao Parkinsonismo por 1-metil-4-fenil-1,2,3,6-tetrahidropiridina (MPTP). MATERIAIS E MÉTODOS: Utilizaram-se 24 ratos Wistar machos, com idade de 13 semanas e peso de 279 ± 13 g, divididos em quatro grupos: 1- controle-controle (n = 6): sham tratados com benserazida + salina; 2 - controle-L-DOPA (n = 6): sham tratados com benserazida + L-DOPA; 3 - MPTP- controle (n = 6): lesão na substância negra (SNc) por MPTP tratados com benserazida + salina; 4 - MPTP-L-DOPA (n = 6): lesão na SNc por MPTP tratados com benserazida + L-DOPA. Esses animais foram submetidos a eutanásia 35 dias após os procedimentos experimentais. Foram analisados: peso corporal, peso muscular, morfologia geral do músculo com microscopia de luz e mensuração da área de secção transversa das fibras musculares. Realizaram-se comparações com o teste t pareado entre o peso corporal inicial e final. A ANOVA post-hoc Tukey foi usada para comparações entre os grupos, sendo considerado significativo p ≤ 0,05. RESULTADOS: Não foram encontradas diferenças estatisticamente significativas nas variáveis analisadas. CONCLUSÃO: Os dados analisados não excluem a possibilidade de alterações ocorrerem no interior dessas células, nos tipos de fibras musculares ou em longo prazo.

INTRODUCTION: Animal models for Parkinson's disease (PD) which mimetize dopaminergic degeneration of nervous cells have been developed to study the pathology of this disease and to analyze the efficiency of new therapies. One of the cardinal signs of PD have muscle stiffness, studies suggest that intrinsic changes in mechanical properties of muscle may be responsible for the increase of this amendment tonic. OBJECTIVE: To analyze the morphology and histomorphometry of soleus muscle of rats PD-induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropiridine (MPTP). MATERIALS AND METHODS: We used 24 male Wistar rats, with the age of 13 weeks and 279 ± 13 g weight, divided into four groups: 1- control-control (n = 6): sham treated with benserazidasalina; 2 - control-L-DOPA (n = 6): sham treated with benserazida + L-DOPA; 3 - MPTP-control (n = 6): injury in substantia nigra (SNc) by MPTP treated with benserazidasalina; 4 - MPTP-L-DOPA (n = 6): CNS injury by MPTP treated with benserazida + L-DOPA. These animals were euthanized 35 days after the experimental procedures. It was analyzed: body weight, muscle weight, General muscle morphology with light microscopy and measurement of the cross-sectional area of muscle fibers. Comparisons between initial and final body weight were developed with the paired T-test. The Tukey post-hoc ANOVA was used for comparisons between groups, being considered significant p ≤ 0.05. RESULTS: No statistically significant differences were found in the analyzed variables. CONCLUSION: The data analyzed do not exclude the possibility of occurrence of changes in the interior of these cells, in the types of muscle fibers or long term.

Muscular Rigidity and Pulmonary Edema Following Administration of Low Dose Fentanyl: A Case Report / 대한구급학회지

Fentanyl-induced muscular rigidity has been reported exclusively in patients when large fentanyl dosages were employed in the operating room or in the pediatric intensive care unit. Rigidity and pulmonary edema after analgesic doses of fentanyl had not been reported previously. A 25-year-old man underwent removal of a foreign body and application of an Ilizarov frame of tibia under general anesthesia. The patient received 100 microg of fentanyl during emergence of anesthesia and the procedure of dressing. On arrival to the anesthetic recovery room, the patient presented with muscular rigidity and about 1 hour later, developed pulmonary edema. The notable predisposing factors were rapid injection of fentanyl and history of treatment with antidepressants and haloperidol, modifiers of serotonin and dopamine levels. From this case, we suggest the need for careful observation for the development of muscle rigidity complicating airway management in patients taking antidepressants and antipsychotics, especially after administration of an analgesic dose of fentanyl.

Síndrome neuroléptico maligno / Neuroleptic Malignant Syndrome

Introducción: El síndrome neuroléptico maligno (SNM) es una urgencia médica potencialmente fatal hasta en 11,6% de los casos, y se relaciona con agentes que alteran la neurotransmisión del sistema dopaminérgico. La incidencia se calcula en 0,2 a 3,23. Objetivos: Revisar la caracterización del SNM y abordar su fi sopatología. Método: El SNM se caracteriza por rigidez, temblor, fi ebre, alteración del estado de conciencia, disautonomía, leucocitosis y elevación de la creatinfosfokinasa; aunque la fi siopatología no se conoce claramente, se han implicado, por una parte, un bloqueo de la dopamina por fármacos y, por otra, una predisposición del músculo esquelético a tener un mal manejo de las reservas de calcio. Conclusiones: El diagnóstico debe ser precoz e incluir en medidas generales de soporte y terapéutica farmacológica sintomática. Toda la atención debe orientarse a prevenir complicaciones comunes: broncoaspiración, desgaste, escaras, procesos infecciosos y cambios neuropsiquiátricos. Luego de este episodio es necesario prevenir la exposición al fármaco que generó el cuadro clínico y se deben detectar recurrencias con la exposición a nuevas moléculas de antipsicóticos.

Introduction: Neuroleptic malignant syndrome is a medical emergency that is potentially fatal up to 11.6% of cases and is related to the use of agents that alter the functioning of dopaminergic systems. The estimated incidence is calculated between 0.2 to 3.23. Objective: It is characterized by rigidity, tremor, fever, consciousness impairment, dysautonomy, lucocytosis and rise in creatinphosphokinase levels. Method: Although physiopathology is unknown, the blocking of dopamine by drugs and a predisposition of skeletic muscle to deal ineffi ciently with calcium stores have both been implicated. Conclusions: Due to the severity of this pathology, diagnosis must be done early and include in treatment plan general support measures and symptomatic pharmacological treatment. The treatment must be oriented towards prevention of common complications like aspiration, infections, wounds and neuropsychiatric disturbances. After the episode it is necessary to prevent the exposition to the medication that generated the problem and to detect recurrence with the exposition to new antipsychotic molecules.

Malignant Hyperthermia after Incomplete Relaxation of masseter Muscle / 대한마취과학회지

Masseter muscle rigidity may herald a fulminant malignant hyperthermia reaction or may be an isolated abnormal anesthetic response. It is very hard to differentiate, Significant masseter muscle rigidity is a muscle spasm of at least 30 seconds duration that interferes with mouth opening despite an appropriate succinylcholine dose in a patient who has no temporo-mandibular joint dysfuntion. They thought mild to moderate foims of spasm are tolerable for anesthesia. We suffered incomplete relaxation of masseter muscle after succinylcholine that followed by fulminant malignant hyperthermic reaction. At that time, a little resistance was felt during mouth opening put intubation was done . without difficulty. After this experience, because Caffeine-Halothane contracture test is performed only in limited institutes and dantrolene is not available in our hospital, we decide to hold the anesthetic practice in case of any degree of masseter muscle rigidity.

Anesthetic Induction with Fentanyl / 대한마취과학회지

We evaluated the efficacy as an anesthetic induction agent and cardiovascular effects of fentanyl in sixty patients with myocardial ischemia on electrocardiogram, who were scheduled for elective operations of more than two-hour duration. In addition, the effects of pretreatment with pancuronium and/or lorazepam prior to anesthetic induction were evaluated on the induction speed, the incidence and severity of skeletal muscle rigity, heart rate, and systolic blood pressure. All the patients were given 30ug/kg of fentanyl and divided into four equal groups of fifteen patients according to pretreatment drugs administered before fentanyl. The results were as follows: 1) Eighty-seven percent of the patients in control group (pretreated with saline)were rendered unconscious during or one minute after infusion of 30ug/kg of fentanyl. 2) Pretreatment with lorazepam before fentanyl significant#ly increased the induction speed (p 0.05). From the above results, it is concluded that anesthetic induction with 30 ug/kg of fentanyl produces profound analgesia and amnesia, stable cardiovascular dynamics, and a minimum of problems, and pretreatment with small doses of lorazepam and pancuronium before fentanyl facilitates not only a rapid loss of consciousness but also a reduction in the incidence and severity of fentanyl-induced rigidity.