Neck circumference and its association with anthropometric, clinical, and biochemical parameters in patients with chronic kidney disease on hemodialysis / Circunferência do pescoço e sua associação com parâmetros antropométricos, clínicos e bioquímicos em pacientes com doença renal crônica em hemodiálise

ABSTRACT Objective: To investigate the association between neck circumference and anthropometric, clinical, and biochemical parameters in chronic kidney failure patients on hemodialysis. Methods: This is a cross-sectional study with patients with chronic kidney disease undergoing hemodialysis in Western Bahia. For the data collection, anthropometric measures were taken and clinical and biochemical data were gathered from the patient records and employing a structured questionnaire. A multiple linear regression was applied to evaluate the relationship between neck circumference and the anthropometric, clinical, and biochemical parameters. Results: A total of 119 patients were evaluated, of which 63.03% were men and 57.98% were aged between 35 and 59 years old. The mean neck circumference of the patients was 36.2±3.8 cm. A negative association was found between neck circumference and the female sex (p<0.001), while waist circumference (p<0.001), the body adiposity index (p=0.002), and pre-dialysis serum urea concentration (p=0.006) were positively associated with neck circumference. Conclusion: Neck circumference is inversely associated with the female sex and positively associated with a high waist circumference, body adiposity index, and serum urea concentration in patients with chronic kidney disease on hemodialysis.

RESUMO Objetivo: Investigar a associação entre circunferência do pescoço e parâmetros antropométricos, clínicos e bioquímicos em pacientes renais crônico sem hemodiálise. Métodos: Trata-se de um estudo transversal com pacientes com doença renal crônica em hemodiálise no Oeste da Bahia. Para a coleta de dados foram aferidas medidas antropométricas e dados clínicos e bioquímicos foram coletados dos prontuários dos pacientes e por meio de um questionário estruturado. A análise de regressão linear múltipla foi aplicada para avaliar a relação entre a circunferência do pescoço e os parâmetros antropométricos, clínicos e bioquímicos. Resultados: Foram avaliados 119 pacientes, sendo 63,03% homens e 57,98% com idade entre 35 e 59 anos. A média da circunferência do pescoço dos pacientes foi de 36,2±3,8 cm. Foi encontrada associação negativa entre a circunferência do pescoço e sexo feminino (p<0,001), enquanto a circunferência da cintura (p<0,001), o índice de adiposidade corporal (p=0,002) e a concentração sérica de ureia pré-diálise (p=0,006) foram positivamente associados à circunferência do pescoço. Conclusão: A circunferência do pescoço está inversamente associada ao sexo feminino e positivamente associada a uma circunferência abdominal elevada, índice de adiposidade corporal e concentração sérica de ureia em pacientes com doença renal crônica em hemodiálise.

Enfrentamiento a una masa cervical no tiroidea en Atención Primaria / Confrontation with a non-thyroid cervical mass in Primary Care

The clinical approach to non-thyroid cervical masses in primary care has always been considered a diagnostic challenge. In the absence of specific diagnostic methods, the general practitioner must rely on clinic and general tests in order to achieve a suspected diagnosis and timely referral. On initial approach to cervical masses, one must first analyze each case according to patient age, associating an exhaustive anamnesis focused on the growth pattern and aggregate symptoms, along with a physical examination focused on signs of malignancy. Once completed, the etiology of the mass can be classified as probable congenital, inflammatory or tumoral origin. And also try to determine localization, temporality and discriminate between benign and malignant causes. Once the clinical interrogation has been completed, basic complementary tests and/or directed test according to suspicion can be requested. The foregoing allows the primary care physician a proper referral to specialist and/or initiation of appropriate treatment. (AU)

Infecciones profundas del cuello / Deep neck infections

Deep neck infections (DNIs) are special entities among infectious diseases for their versatility and potential for severe complications. Complex head and neck anatomy often makes early recognition of DNIs challenging, and a high index of suspicion is necessary to avoid any delay in treatment. The diagnosis is made by clinical history, physical examination findings and imaging studies. The treatment consists in securing the airway, intravenous antibiotics and surgical drainage, when needed. To make decisions the surgeon must understand the anatomy of the region, the etiology of infection, appropriate diagnostic tools, and medical and surgical management. This article provides a review of these pertinent topics. (AU)

Pain intensity and cervical range of motion in women with myofascial pain treated with acupuncture and electroacupuncture: a double-blinded, randomized clinical trial

BACKGROUND: Acupuncture stimulates points on the body, influencing the perception of myofascial pain or altering physiologic functions. OBJECTIVE: The aim was to evaluate the effect of electroacupuncture (EAC) and acupuncture (AC) for myofascial pain of the upper trapezius and cervical range of motion, using SHAM acupuncture as control. METHOD: Sixty women presenting at least one trigger point at the upper trapezius and local or referred pain for more than six months were randomized into EAC, AC, and SHAM groups. Eight sessions were scheduled and a follow-up was conducted after 28 days. The Visual Analog Scale assessed the intensity of local and general pain. A fleximeter assessed cervical movements. Data were analyzed using paired t or Wilcoxon's tests, ANOVA or Friedman or Kruskal-Wallis tests and Pearson's correlation (α=0.05). RESULTS: There was reduction in general pain in the EAC and AC groups after eight sessions (P<0.001). A significant decrease in pain intensity occurred for the right trapezius in all groups and for the left trapezius in the EAC and AC groups. Intergroup comparisons showed improvement in general pain in the EAC and AC groups and in local pain intensity in the EAC group (P<0.05), which showed an increase in left rotation (P=0.049). The AC group showed increases in inclination (P=0.005) sustained until follow-up and rotation to the right (P=0.032). CONCLUSION : EAC and AC were effective in reducing the pain intensity compared with SHAM. EAC was better than AC for local pain relief. These treatments can assist in increasing cervical range of motion, albeit subtly. .

Asociación entre maloclusiones y posición de la cabeza y cuello / Association between Malocclusion and Position of the Head and Neck

Con la finalidad de contrastar la hipótesis nula "no hay asociación entre maloclusiones y alteraciones posturales de cabeza y cuello" se realizó un estudio descriptivo transversal en pacientes que consultaron por tratamiento de ortodoncia. La muestra consistió en 116 pacientes con maloclusión atendidos en el Programa de Especialización en Ortodoncia y Ortopedia Dento Máxilo Facial 2007-2009 de la Facultad de Odontología de la Universidad de Chile. Se analizaron las fichas de cada uno de ellos y se buscó asociación entre los valores del Análisis Cráneo Cervical de Rocabado, el cefalograma, estudio de modelos y la evaluación funcional de la lengua. Se encontró asociaciones estadísticas débiles entre la rotación anti horaria del cráneo (ángulo cráneo vertebral y distancia intervertebral C0-C1 disminuidas), con clase III esqueletal que además tenían rotación posterior mandibular y que eran dólico faciales. Altos valores del triángulo hioideo, se asociaron débilmente, con Clase II esqueletal, junto con alteraciones de la posición de la lengua en reposo y retrusión dentaria. Se concluye que en pacientes con maloclusión existe una asociación estadísticamente débil con alteraciones de la postura craneocervical.

In order to test the null hypothesis "there is no association between malocclusion and postural alterations in head and neck" a non-experimental analytical study was carried out in patients with clinical orthodontic treatment. The sample consisted of 116 patients with malocclusion treated at the Specialization Program in Orthodontics and Dento Maxillo Facial Orthopedics from 2007 to 2009, Faculty of Dentistry, Universidad de Chile. We analyzed the records of each patient, for search partnership between the values of Cervical Skull Rocabado Analysis, the cephalogram and study models. We found weak statistical associations between anti-rotation time of the cranium (skull, vertebral angle and distance diminished intervertebral C0-C1), with skeletal class III also had mandibular posterior rotation and were dolicho facial. High values of the hyoid triangle, were weakly associated with skeletal Class II, along with changes in tongue position at rest and dental retrusion. We conclude that in patients with malocclusion there is a statistically weak association with altered craniocervical posture.

Lipomatose simétrica benigna: doença de Madelung: relato de caso / Benign symmetric lipomatosis: Madelung's disease: case report

JUSTIFICATIVA E OBJETIVOS: A lipomatose simétrica benigna (LSB) foi descrita inicialmente por Madelung em 1888 e possui patogênese ainda desconhecida. É caracterizada por múltiplos depósitos de gordura indolor não encapsulado com disposição simétrica, localizados preferencialmente na região cervical e tronco superior, podendo causar sintomas compressivos e aparência pseudoatlética. O tratamento cirúrgico é o mais efetivo, por ressecção ou por lipossucção. O objetivo deste relato foi apresentar a importância do caso descrito, devido à sua exuberância clínica, apesar de assintomática e sem alterações significativas laboratoriais.RELATO DO CASO: Paciente do sexo masculino, 77 anos, agricultor, natural de Pernambuco. Relatou que há oito meses apresentava crescimento progressivo de massa indolor na região cervical, occipital e superior do tórax, negando outros sintomas que pudessem acompanhar o crescimento e sem história familiar. Hipertenso, etilista e tabagista. Ao exame constatou-se massa volumosa simétrica cervical fibroelástica, na região cervical, não aderida a planos profundos e sem sinais flogísticos.CONCLUSÃO: A LSB foi classificada por Enzi e col. em dois tipos, o paciente em questão foi classificado como tipo I, lipoma predominantemente cervical. A ingesta de álcool consumida pelo paciente tem forte associação com a etiologia da doença de acordo com Enzi e col. Foi realizada lipectomia, com abordagem em dois tempos cirúrgicos devido a invasão de estruturas nobres. O paciente evoluiu bem clinicamente, sem complicações, com bom resultado estético. O presente caso apresentava uma exuberância clínica não condizente com os parâmetros laboratoriais e sintomatologia descrita na literatura.(AU)

BACKGROUND AND OBJECTIVES: Benign symmetric lipomatosis (BSL) was first described by Madelung in 1888 and still has unknown pathogenesis. It is characterized by multiple unencapsulated painless fat deposits with symmetrical disposition, preferably located in the cervical region and upper trunk and may cause compressive symptoms and pseudoathletic appearance. Surgical treatment is most effective, and it could be done by resection or liposuction. The objective of this study was to present the importance to describe the case due to your clinical exuberance without symptoms or significant changes in laboratory tests.CASE REPORT: Male patient, 77 years old, farmer, born in Pernambuco. Reported that 8 months ago began progressive growth of a painless mass in the cervical region, occipital region and upper chest, with no family history. He has high blood pressure, alcoholic and smoker. On examination, it could be noticed a large fibroelastic symmetric mass, asymptomatic, in the cervical region, not adhered to deep planes and with no signs of inflammation.CONCLUSION: The benign symmetric lipomatosis was rated by Enzi et al. in two types, the patient in this case was classified as type I, predominantly cervical lymphoma. The intake of alcohol consumed by the patient is strongly associated with the etiology of this disease, according to Enzi et al. The patient underwent a lipectomy with a two steps approach due to surgical invasion of vital structures. The patient was stable clinically, without complications, with good aesthetic results. The clinical case described had an exuberance of clinical manifestations, not consistent with laboratory parameters and symptoms described in the literature.(AU)

Infecções cervicais profundas: classificação em níveis de gravidade / Deep neck infections - classification in levels of severity

Introdução: As infecções dos espaços cervicais constituem quadros graves e que apresentam elevada mortalidade quando evoluem com complicações. Objetivo: Estabelecer um protocolo de graduação dos abscessos cervicais e organizar uma sequência para o atendimento desses pacientes. Método: Foi realizado um estudo retrospectivo de 150 pacientes portadores de abscesso cervical no qual se avaliou a impressão clínica, estado geral, condição respiratória, estado loco-regional, antibióticos utilizados e comorbidades. Após, organizou-se a classificação em níveis de gravidade. Resultados: A idade média foi de 31 anos e em 37% dos casos a origem era dentária. Na avaliação loco - regional em 67% o acometimento se estendia até nível I e II. Conforme a gravidade, os pacientes foram classificados da seguinte maneira: Grau I (46%), II (36%), III (15%) e IV (3%). Somente antibioticoterapia foi utilizada em 27% dos casos. A associação com cirurgia ocorreu em 73% Conclusão: A padronização da conduta terapêutica e a sua classificação em gravidade é fundamental para a sistematização do atendimento e diminuição da morbi-mortalidade.

Introduction: The cervical spaces infections compose severe pictures and result in a high degree of mortality when they evolve with complications. Objective: To set up a graduation protocol of the cervical abscesses and organize a sequence to treat these patients. Method: We carried out a retrospective study of 150 patients with cervical abscess in which we evaluated the clinical impression, general state, respiratory state, locoregional state, antibiotics used and comorbidity. Then we organized a classification with severity levels. Results: The mean age was of 31 years old and in 37% of the cases the origin was dental. In the locoregional evaluation in 67% the affection expanded up to level I and II. According to the severity, the patients were classified as follows: Level I (46%), II (36%), III (15%) and IV (3%). Only antibiotic therapy was used in 27% of the cases. The association with surgery occurred in 73% Conclusion: The therapeutic procedure standardization and its classification in severity is essential for the service systematization and reduction of morbimortality.

Balance disorders in the elderly and the benefit of balance exercise.

Symptoms of balance disorders including 'unsteadiness', 'dizziness and vertigo' are common in the elderly and commonly found in general practice in medicine. There are many causes of balance disorders and vary from one person to another. Disorder of the internal ear or vestibular end-organ type is one cause. Unsteadiness of somato-sensory or proprioception is common in the elderly so is degenerative disorder of central control in brain. The elderly are prone to many chronic illnesses or disorders which are causes of balance disorder or give rise to more rapid degeneration of the central nervous system i.e. high blood pressure, diabetes mellitus, heart disease, proprioception and joint problems, arthritis and muscular weakness due to lack of good health and exercise. The objectives of this research study were to find the etiologies of balance disorders and how Balance Exercises and the 'National Health Service' can be of benefit in helping to prevent them. 1565 elderly inhabitants (age > or = 60 years) of 20 communities adjacent to Siriraj Hospital were selected for study. Among these, 625 persons had a history of balance disorders. Among those, 256 had symptoms during the week selected for examination. The average age was 66 years old, women outnumbered men with a ratio of 2.4:1. The common underlying causes were hypertension in 32.4%, diabetes mellitus 13.8%, arthritis 8.1%, and heart disease 4.4% respectively. All are still taking one or more types of drug. The subjects were randomly divided into two groups for the study purpose of effectiveness of balance exercise. Group 1 did not perform the head balance exercise and Group 2 performed the head balance exercise. Audiometric testing showed impaired hearing in 90% of the subjects. The majority slowed hearing loss in high frequencies. Testing of middle ear function found 75% of Group 1 to have normal middle ear function 77% of Group 2. Brainstem Electrical Response Audiometry (BERA) showed normal response latencies of in 96% of group 1 and 94% of Group 2. Poor morphology of waveform was found in 12% of Group 1 and 16% of Group 2. Doppler sonography for intra-cranial blood flow measurement showed abnormal flow of the ICA in 17.6% of group 1 and 20.16% of group 2. Basilar arterial abnormal flow was found in 77.6% of Group 1 and 80.6% of Group 2 respectively. The flow of ICA was improved after 8 weeks in both groups. The measurement of balance by Posturography showed 86.7% abnormality in Group 1 and 83.5% abnormality in Group 2 (and the majority due to inner ear problems but many cases had a mixture of joints and CNS problems too). Results of the self-evaluation (by questionaires) showed the elderly to have symptoms of light headedness in 51% and loss of balance in 29%, Vertigo with rotation occurred in 23.6%. 49% of the symptoms were intermittent, 56.4% experienced a 'fall". On questioning about the benefit and performance of Head and Neck Exercises, 82.8% found the exercises were easy to perform, 56.4% said the results were very beneficial.

Cuatro exclusivos tests para diferenciar el vértigo cervical

Desde comienzos del siglo XX se sabe, por experimentos en gatos, que el cuello juega un papel significativo en la postura y el equilibrio. Investigaciones en animales demuestran la existencia de sensores provenientes de las cápsulas sinoviales de las articulaciones cervicales. El rol exacto de éstas en el equilibrio se dificulta por la posible participación conjunta de otros órganos del cuello como el muscular, vascular y sistema simpático. Se intenta demostrar, mediante métodos de exámenes clínicos diferentes, que las reacciones obtenidas con estimulaciones funcionales son sólo propias, y diferentes de las articulaciones cervicales. Para ello se estimularon los sensores propioceptivos de las articulaciones facéticas de los huesos cervicales usando: 1. un martillo de 900 gr, con una gruesa punta de goma; 2. una plataforma vibrante, para realizar el test de posturografía; 3. una electronistagmografía; y 4. una herramienta en vibración con una gruesa punta de goma. De un total de 2.304 pacientes que consultaron en vértigo, y a quienes se les hicieron estos tests, el 9,8 por ciento demostró que se trataba de un vértigo cervical, pues el resto de los enfermos no mostraron alteración alguna. La articulación atlanto-axoídea fue la más frecuentemente afectada. Los síntomas de consulta más comunes fueron el desequilibrio, seguido por el vértigo giratorio, la oscilopsia y drop attacks.

Doença de Madelung (lipomatose cervical benigna simétrica): relato de dois casos / Madelung's disease (symmetric benign cervical lipomatosis): report of two cases

Os autores relatam dois casos da doença de Madelung, que consiste em depósitos simétricos de gordura localizados no pescoço, ombros e mediastino superior, envolvendo nervos e vasos. Recomenda-se o uso da tomografia computadorizada, a qual confirma a natureza lipóide da massa, útil no estadiamento pré-operatório e acompanhamento pós-cirúrgico

The authors report two cases of patients with Madelung's disease, a symmetric fat deposit in the neck and superior mediastinum that involves nerves and vessels. Computed tomography can reveal the fat contents of these masses and guide preoperative staging and post-surgical follow-up.

Nocardiose ganglionar como primeira manifestaçäo em um paciente com Síndrome de Imunodeficiência Adquirida (Sida): relato de caso e revisäo da literatura / Ganglionar nocardiosis as the first manifestation of an AIDS patient: case report and literature review

Os autores descrevem um caso de nocardiose linfonodal como manifestação inicial da infecção por HIV. Os aspectos patogênicos, o diagnóstico e a conduta medicamentosa são discutidos com base na literatura atual

Infecciones profundas del cuello en el niño / Deep neck infections in children

Las infecciones profundas cervicales, a excepción de los abscesos periamigdalianos, son poco frecuentes en pediatría. Sin embargo, cuando aparecen en esta edad muestran un elevado riesgo de presentar complicaciones graves, tales como la obstrucción de la vía aérea, con una morbilidad y mortalidad que justifican que el pediatra tenga un conocimiento general de esta patología así como de su tratamiento adecuado

A importância do conhecimento das cadeias ganglionares da cabeça e do pescoço / The applied value of the head and neck lymph nodes knowledge

Os autores apresentam uma seqüência lógica e didática para o entendimento das cadeias ganglionares da região da cabeça e do pescoço, bem como seus envolvimentos com processos patológicos e a aplicação prática na clínica estomatológica e bucomaxilofacial.

Síndrome de pinzamiento del manguito rotador, asociado a radiculopatía cervical: manejo quirúrgico / Impingement syndrome of the rotator cuff, associated to cervical radiculitits: surgical treatment

Determinar la utilidad del manejo medicoquirúrgico en el dolor crónico del hombro, en pacientes con síndrome de pinzamiento del manguito rotador asociado con radiculopatía cervical. Diseño del estudio: se trata de una cohorte retrospectiva de 17 pacientes con dolor crónico de hombro y cuello, evaluados mediante ultrasonografía (US), electromiografía (EMG), además de la prueba de instilación de lidocaína. A todos los pacientes se les realizó liberación quirúrgica del espacio subacromial. Las mediciones del dolor de hombro y cuello se llevaron a cabo mediante la escala visual análoga (EVA) y la movilidad del hombro se evaluó mediante escala funcional. Se estudiaron a 17 pacientes, 10 de sexo masculino y 7 de sexo femenino, todos los pacientes mostraron disminución significativa del dolor, tanto en hombro como en cuello, posterior a la liberación quirúrgica del espacio subacromial, además de lograr una función adecuada del hombro. En pacientes portadores de síndrome de pinzamiento del manguito rotador, asociado a radiculopatía cervical debe efectuarse liberación del espacio subacromial. El manejo conservador de la radiculopatía cervical se facilita en este tipo de pacientes posterior al tratamiento quirúrgico del hombro

Kikuchi's disease [histiocytic necrotizing lymphadenitis]: a chinicopathologic study of 10 cases

Ten patients having Kikuchi's Lymphadenitis diagnosed in our department between 1993 - 1996 were studied. There were 8 females and 2 males, ranging in age from 6 years to 43 years. All the patients presented with cervical lymph node enlargement. Associated clinical findings were fever and raised ESR. Histologically the lymph nodes showed cortical or paracortical patchy pale stained areas, conspicuous foci of necrosis with abundant nuclear and eosinophilic granular debris, surrounded by histiocytes, plasmacytoid monocytes and immunoblasts. Neutrophils were notably absent or scarce. Perinodal inflammation was common. Recognition of Kikuchi's disease by clinicians and pathologists is important, because it may mimic diseases which require specific treatment. Its distinction from malignant lymphoma and lupus lymphadenitis is emphasized in this paper