ABSTRACT
We report a case of leptospirosis that occurred after elective surgery involving tendon transfer and shoulder arthroscopy. The disease mimicked hospital infection after orthopedic surgery and was at first misdiagnosed as post-operative sepsis. The patient was 60 year old female that developed sepsis with hypotension, shock, bleeding, jaundice and renal insufficiency 4 hours after surgery. Shock treatment procedures were performed and broad spectrum antibiotic therapy was used with coverage for bacteria acquired in hospitals. A careful investigation was carried out by the Hospital Infection Control Service in search of the possible source of the infection. After clinical evaluation by a specialist in infectious diseases, the hypothesis of leptospirosis was put forward based on clinical and epidemiological data. The hypothesis was later confirmed by the positive result of serological tests with the microagglutination method that yielded 1:800 and then 1:12,600 7 days later. This is the first reported case of leptospirosis manifest directly following surgery, mimicking postoperative sepsis.
Subject(s)
Arthroscopy/adverse effects , Shoulder/surgery , Weil Disease/diagnosis , Weil Disease/etiology , Diagnosis, Differential , Fatal Outcome , Female , Humans , Leptospira/isolation & purification , Middle Aged , Postoperative Complications , Sepsis/diagnosisABSTRACT
INTRODUCTION: Friedreich's ataxia is a neurodegenerative disorder whose clinical diagnostic criteria for typical cases basically include: a) early age of onset (< 20 or 25 years), b) autosomal recessive inheritance, c) progressive ataxia of limbs and gait, and d) absence of lower limb tendon reflexes. METHODS: We studied the frequency and the size of expanded GAA and their influence on neurologic findings, age at onset, and disease progression in 25 Brazilian patients with clinical diagnosis of Friedreich's ataxia - 19 typical and 6 atypical - using a long-range PCR test. RESULTS: Abnormalities in cerebellar signs, in electrocardiography, and pes cavus occurred more frequently in typical cases; however, plantar response and speech were more frequently normal in this group when the both typical and atypical cases were compared. Homozygous GAA expansion repeats were detected in 17 cases (68%) - all typical cases. In 8 patients (32%) (6 atypical and 2 typical), no expansion was observed, ruling out the diagnosis of Friedreich's ataxia. In cases with GAA expansions, foot deformity, cardiac abnormalities, and some neurologic findings occurred more frequently; however, abnormalities in cranial nerves and in tomographic findings were detected less frequently than in patients without GAA expansions. DISCUSSION: Molecular analysis was imperative for the diagnosis of Friedreich's ataxia, not only for typical cases but also for atypical ones. There was no genotype-phenotype correlation. Diagnosis based only on clinical findings is limited; however, it aids in better screening for suspected cases that should be tested. Evaluation for vitamin E deficiency is recommended, especially in cases without GAA expansion.
Subject(s)
Friedreich Ataxia/genetics , Trinucleotide Repeat Expansion/genetics , Age of Onset , Female , Genotype , Humans , Male , PhenotypeABSTRACT
OBJETIVO - Verificar as alteraçöes provocadas pelo treinamento físico (TF), com membros superiores (MMSS), em condição aeróbia de curta duração, sobre variáveis dos sistemas cardiovasculares e metabólico. MÉTODOS - Foram estudados 11 deficientes físicos (DF) paraplégicos, com média de idade de 59 anos,sendo 7 homens e 4 mulheres, com lesão de T9 a T11 e grau leve de hipertensão arterial sistêmica (HAS). Os DF foram avaliados antes e após 12 semanas de um programa de TF supervisionado de MMSS, por meio de teste ergométrico (TE) em cicloergômetro mecânico adaptado para MMSS, utilizando-se protocolo intermitente com incremento de carga de 125kgm/min (20w) para mulheres e 140kgm/min (25w) para homens a cada 3 min., em velocidade que variou de 83 a 95rpm. O consumo de oxigênio (VO2) foi calculado de acordo com a equação para MMSS do American College of Sports Medicine. A intensidade do exercício durante o programa de TF foi estabelecida pela reserva de frequência cardíaca (RFC) de Karvonen, com variação de 65 'por cento' a 85 'por cento' e escala de percepção subjetiva ao esforço de Borg obtida pelo TE. RESULTADOS - A capacidade aeróbia máxima estimada aumentou 22 'por cento' (930ñ349 vs 1138ñ290mLmin; p=0,003); a pressão arterial sistólica (PAS) e a diastólica (PAD) em repouso e no exercício submáximo diminuíram em 4 'por cento', 15 'por cento' e 5 'por cento', 5 'por cento', respectivamente. CONCLUSÄO - o TF aeróbio de intensidade leve a moderada com MMSS, além de melhorar a aptidão funcional exerce também papel importante como modelo terapêutico não medicamentoso na resposta hipertensiva observada de DF paraplégicos.
Subject(s)
Humans , Male , Female , Animals , Arterial Pressure , Disabled Persons , Exercise , Hypertension , Follow-Up Studies , Time FactorsABSTRACT
PURPOSE: To study the modifications induced by physical training (PT) using upper limbs in aerobic condition of short duration on cardiovascular and metabolic variables. METHODS: Eleven paraplegic persons, with a mean age of 59 years, 7 men and 4 women with lesions at T9 through T11 and mild hypertension (HAS) were studied. The patients were studied before and after 12 weeks of a supervised program of PT, through exercise tests in a mechanic ergometer (ST) adapted for the arms. We employed an intermittent protocol with stress increments of 125 (20w) and 140 kgm/min (25w) for women and men, respectively every 3 min. The ergometric speed ranged from 83 to 95 rpm. The oxygen consumption (VO2) was estimated according to American College of Sports Medicine equation for arms. The exercise intensity during the TF program was estimated through the Karvonen cardiac frequency reserve, with a variation of 65% to 85% and the Borg stress scale of subjective perception during the stress test. RESULTS: The mean maximal aerobic capacity increased in 22% (930 +/- 349 vs 1138 +/- 290 mL/min; p = 0.003); there was a reduction of systolic and diastolic pressures at rest and after submaximal exercise of 4%, 15% and 5% and 5%, respectively. CONCLUSION: Physical training of mild to moderate intensity using the upper limbs in paraplegic persons, besides inducing functional capacity increment, is an important model of non drug control of the hypertensive response.
Subject(s)
Arm , Exercise Therapy/methods , Heart Rate , Hypertension/rehabilitation , Paraplegia/rehabilitation , Energy Metabolism , Female , Humans , Hypertension/physiopathology , Male , Middle Aged , Oxygen Consumption , Paraplegia/physiopathology , Time FactorsABSTRACT
With the objective of studying the prognosis for walking in children with cerebral palsy a retrospective survey of 100 children being treated at the Associação de Assistência à Criança Defeituosa was made during the period from 1979 to 1988. The following parameters were analysed: (1) degree of motor dysfunction; (2) age of acquisition of sitting balance; (3) function of upper limbs; (4) degree of mental retardation; (5) presence of primitive reflexes. All the above parameters were analysed with respect to the capability of children acquiring or not walking. The results of our study show that the following factors are indicative of bad prognosis for walking: (1) severity of motor dysfunction; (2) acquisition of sitting posture after 3 years old; (3) precarius function of upper limbs; (4) severe mental retardation associated with severe physical deficiency. Clinical evaluation of primitive reflexes did not reveal direct relation to the walking prognosis.
Subject(s)
Cerebral Palsy/physiopathology , Walking/physiology , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Prognosis , Retrospective StudiesSubject(s)
Audiology , Cerebral Palsy/therapy , Learning , Occupational Therapy , Orthoptics/methods , Physical Therapy Specialty , Psychology , Speech Therapy , Cerebral Palsy/classification , Cerebral Palsy/complications , Cerebral Palsy/diagnosis , Cerebral Palsy/epidemiology , Cerebral Palsy/etiology , Cerebral Palsy/physiopathology , Cerebral Palsy/prevention & control , Cerebral Palsy/rehabilitation , Mother-Child RelationsABSTRACT
One hundred patients from a total of 239 paraplegic patients were surveyed after at least 6 months in community life in order to assess the value of the rehabilitation programme. The patients' average age was 24 years, and the highest neurological level being T1. All patients had received intensive care, the average time being 4.7 months. The results were similar to those described in the literature, but the lower socio-economic levels and the absence of comprehensive initial care in general hospitals soon after trauma were negative factors. It is concluded that (1) Brazil requires medical and paramedical staff with specific training for the acute phase in more Rehabilitation Centres; (2) that paraplegics are greatly benefited by a rehabilitation programme; (3) the Brazilian Social Security should sponsor the rehabilitation programme.
