Efeitos da acupuntura nos acupontos Shenmen (C-7) e Neiguan (PC-6) sobre a frequência cardíaca, a variabilidade da frequência cardíaca e o ritmo cardíaco em cães saudáveis / Effects of acupuncture at Shenmen (C-7) and Neiguan (PC-6) acupoints on the heart hate, heart rate variability and cardiac rhythm in healthy dogs

Acupuncture derives from traditional Chinese medicine, which aims to restore homeostasis. The action mechanism of this technique involves stimulation of certain points on the skin by inserting a needle. The aim of this study was to evaluate the influence of stimulation of acupoints C7 and PC6 on the heart rate variability, heart rate and heart rhythm in healthy dogs. 30 male and female adult dogs were used, with no breed restriction. The animals were analyzed at two different times in weekly intervals. Firstly were applied needles in the true acupoints, and on the second time we applied needles in false acupoints. Previously to the acupuncture an ECG with 2 minutes of recorder was performed, and after an insertion of needles the electrocardiographic recording was maintained during the 30 minutes of acupuncture. Results showed no significant difference between the HR when comparing true and false acupoints (p = 0.890). For heart rate variability a small difference was observed between the groups (p = 0.0051), however, when comparing the baseline with 15 and 25 minutes of monitoring in the false acupoint group, no significant results were found when compared with true acupoint. In conclusion, it is suggested that the stimulation of acupoints C-7 and PC-6 in healthy dogs does not promote change in sympathovagal balance, specifically on the heart rate variability, heart rate and heart rhythm on healthy dogs.(AU)

Efeitos da acupuntura nos acupontos Shenmen (C-7) e Neiguan (PC-6) sobre a frequência cardíaca, a variabilidade da frequência cardíaca e o ritmo cardíaco em cães saudáveis

Acupuncture derives from traditional Chinese medicine, which aims to restore homeostasis. The action mechanism of this technique involves stimulation of certain points on the skin by inserting a needle. The aim of this study was to evaluate the influence of stimulation of acupoints C7 and PC6 on the heart rate variability, heart rate and heart rhythm in healthy dogs. 30 male and female adult dogs were used, with no breed restriction. The animals were analyzed at two different times in weekly intervals. Firstly were applied needles in the true acupoints, and on the second time we applied needles in false acupoints. Previously to the acupuncture an ECG with 2 minutes of recorder was performed, and after an insertion of needles the electrocardiographic recording was maintained during the 30 minutes of acupuncture. Results showed no significant difference between the HR when comparing true and false acupoints (p = 0.890). For heart rate variability a small difference was observed between the groups (p = 0.0051), however, when comparing the baseline with 15 and 25 minutes of monitoring in the false acupoint group, no significant results were found when compared with true acupoint. In conclusion, it is suggested that the stimulation of acupoints C-7 and PC-6 in healthy dogs does not promote change in sympathovagal balance, specifically on the heart rate variability, heart rate and heart rhythm on healthy dogs.

Estudo comparativo da eletrocardiografia convencional e computadorizada em equinos das raças Quarto de Milha e Mangalarga Marchador / Comparative study of computerized and conventional electrocardiography in Quarter Horse and Mangalarga Marchador

A eletrocardiografia computadorizada é mais precisa e prática quando comparada à convencional e por essa razão vem ganhando espaço na rotina clínica. No entanto os valores de referência devem diferir para os dois métodos. O objetivo desse trabalho foi analisar e comparar o exame eletrocardiográfico computadorizado com o exame obtido pelo método convencional em equinos. O estudo demonstrou diferenças na amplitude da onda P (P<0,0001) com valor médio de 0,21 mV para o método convencional e 0,17 mV para o computadorizado; duração do intervalo PR (p=0,0005), tendo o valor médio de 260,49 ms para o método convencional e 242,37 ms para o informatizado e duração do complexo QRS (p=0,0003), sendo a média de valores para o método convencional de 75,61ms e 84,83 ms para o computadorizado. Essas diferenças devem ser levadas em consideração com o intuito de evitar equívocos na interpretação da eletrocardiografia na espécie equina.(AU)

Computerized electrocardiography has been gaining space in clinic routines because it is more practical and precise when compared to the conventional method. However, their reference values may differ from each other. The aim of this paper was to analyze and compare computerized and conventional electrocardiography in horses. Differences were observed between P wave amplitude (P<0001) with a mean of 0.21mV in the conventional method and 0.17mV in the computerized method, PR interval duration (p=0.0005) with a mean of 260.49 ms and 242.37 ms in the conventional and computerized methods respectively, and QRS complex duration (p=0.0003) with a mean of 75.61 ms in the conventional method and 84.83 ms in the computerized method. These differences should be taken into consideration in order to avoid misunderstandings in the interpretation of the electrocardiogram in equine species.(AU)

Estudo comparativo da eletrocardiografia convencional e computadorizada em equinos das raças Quarto de Milha e Mangalarga Marchador / Comparative study of computerized and conventional electrocardiography in Quarter Horse and Mangalarga Marchador

A eletrocardiografia computadorizada é mais precisa e prática quando comparada à convencional e por essa razão vem ganhando espaço na rotina clínica. No entanto os valores de referência devem diferir para os dois métodos. O objetivo desse trabalho foi analisar e comparar o exame eletrocardiográfico computadorizado com o exame obtido pelo método convencional em equinos. O estudo demonstrou diferenças na amplitude da onda P (P<0,0001) com valor médio de 0,21 mV para o método convencional e 0,17 mV para o computadorizado; duração do intervalo PR (p=0,0005), tendo o valor médio de 260,49 ms para o método convencional e 242,37 ms para o informatizado e duração do complexo QRS (p=0,0003), sendo a média de valores para o método convencional de 75,61ms e 84,83 ms para o computadorizado. Essas diferenças devem ser levadas em consideração com o intuito de evitar equívocos na interpretação da eletrocardiografia na espécie equina.

Computerized electrocardiography has been gaining space in clinic routines because it is more practical and precise when compared to the conventional method. However, their reference values may differ from each other. The aim of this paper was to analyze and compare computerized and conventional electrocardiography in horses. Differences were observed between P wave amplitude (P<0001) with a mean of 0.21mV in the conventional method and 0.17mV in the computerized method, PR interval duration (p=0.0005) with a mean of 260.49 ms and 242.37 ms in the conventional and computerized methods respectively, and QRS complex duration (p=0.0003) with a mean of 75.61 ms in the conventional method and 84.83 ms in the computerized method. These differences should be taken into consideration in order to avoid misunderstandings in the interpretation of the electrocardiogram in equine species.

Small Bowel Obstruction due to Intestinal Xanthomatosis.

Vast majority of bowel obstruction is due to postoperative adhesions, malignancy, intestinal inflammatory disease, and hernias; however, knowledge of other uncommon causes is critical to establish a prompt treatment and decrease mortality. Xanthomatosis is produced by accumulation of cholesterol-rich foamy macrophages. Intestinal xanthomatosis is an uncommon nonneoplastic lesion that may cause small bowel obstruction and several cases have been reported in the English literature as obstruction in the jejunum. We report a case of small intestinal xanthomatosis occurring in a 51-year-old female who presented with one day of copious vomiting and intermittent abdominal pain. Radiologic images revealed jejunal loop thickening and inflammatory changes suggestive of foreign body obstruction, diagnostic laparoscopy found two strictures at the jejunum, and a pathologic examination confirmed a segmental small bowel xanthomatosis. This case illustrates that obstruction even without predisposing factors such as hyperlipidemia or lymphoproliferative disorders.

Influence of HLA-DR alleles on rheumatoid arthritis: susceptibility and severity in Argentine patients.

OBJECTIVE: To determine the frequency of shared epitopes in our population of patients with rheumatoid arthritis (RA) and to investigate whether the presence of these alleles is associated with a more aggressive form of disease. METHODS: Demographic and clinical data were obtained from 140 patients with RA, 123 female, mean age 49.9+/-11.7 years and mean disease duration 9.4+/-6.3 years. Radiographs of both hands were taken and scored by Larsen's method. HLA-DR alleles were determined by PCR-SSP. The control group comprised 202 healthy ethnic-matched subjects. RESULTS: DR4 was significantly more frequent in patients with RA than controls, and was observed in 70/140 patients (50%) versus 47/202 controls (23.27%) (odds ratio 3.25, CI 1.99-5.35, Pcorr 5 x 10(-5)). Within DR4 subtypes *0404 and *0401 were the most commonly found (37.7 and 29%, respectively). DR3 and DR11 exerted a protective effect with significantly higher frequency in controls than in patients with RA. When patients were divided into 2 groups according to disease severity (radiographic score) the frequency of alleles with QKRAA and QRRAA sequences was similar in both groups. Although with lower frequency, subtype *1001 alone was significantly more frequent in the severe-condition group [7 (13.5%) vs 3 (3.4%), p = 0.03]. CONCLUSION: These results are in accordance with findings observed in Caucasians and differ from other Latin American populations. However shared epitope alleles failed to correlate with more severe disease with the exception of subtype *1001 which, although infrequent, was significantly more frequent in patients with relevant radiological damage.

The effect of melatonin in patients with fibromyalgia: a pilot study.

The aim of the study was to determine the possible effect of melatonin treatment on disturbed sleep, fatigue and pain symptoms observed in fibromyalgia (FM) patients. Twenty-one consecutive patients with FM were included in an open 4-week-duration pilot study. Before and after treatment with melatonin 3 mg at bedtime, patients were evaluated using tender point count by palpation of 18 classic anatomical regions, pain score in four predesignated areas, pain severity on a 10 cm visual analogue scale (VAS), sleep disturbances, fatigue, depression, anxiety, and patient and physician global assessments, also by a VAS. Urine 6-sulphatoxymelatonin levels (aMT-6S) were measured in the patients and 20 age- and sex-matched controls. Nineteen patients completed the study. One patient withdrew because of migraine and another was lost to follow-up. At day 30, median values for the tender point count and severity of pain at selected points, patient and physician global assessments and VAS for sleep significantly improved with melatonin treatment. Other variables improved but did not reach statistical significance. Adverse events were mild and transient. Lower levels of aMT-6S were found in FM patients compared with normal median controls (+/-SD, 9.16 +/- 7.9 microg/24 h vs 16.8 +/- 12.8 microg/24 h) (p = 0.06). Although this is an open study, our preliminary results suggest that melatonin can be an alternative and safe treatment for patients with FM. Double-blind placebo controlled studies are needed.

Pathological mineralizations: calcifications and Si-bearing particles in soft tissues and their eventual relationship to different prostheses.

Polarizing microscopy (PM), scanning electron microscopy (SEM), x-ray dispersive analysis (EDAX), x-ray diffraction (XRD), and infrared spectrometry (IR) were used to study the following pathological mineralizations: calcifications and silicon(Si)-bearing mineralizations in cerebral tissue from an epileptic child; traces of Si-bearing particles in periprosthesic mammarian tissue, and calcifications in capsular mammarian tissue from a patient with a silicone gel mammarian implant, and 2 calcium-bearing compounds, a typical apatitic calcification, and a nonphosphorous-bearing calcification in arterial tissues. In this tissue we also found Si-bearing particles due to an artifact from glassware.

Jaccoud's arthropathy of the hands in overlap syndrome.

The objective of this work was to evaluate the frequency and features of Jaccoud's syndrome of the hands in patients with overlap syndrome. Twenty-three patients with overlap syndrome were prospectively evaluated by means of a complete physical examination, serological assessment, and hand X-rays. The presence of Jaccoud's syndrome was defined by Kahn's criteria. Patients with or without Jaccoud's arthropathy were compared in their clinical, serological and radiological features. Five out of 23 patients (21.7%) presented Jaccoud's syndrome. Clinical and serological features of patients with or without the syndrome proved similar except for alignment abnormalities, which by definition were more frequent in the group with Jaccoud. A significantly greater number of patients meeting diagnostic criteria for SLE were observed in the Jaccoud group (80% versus 21%; p = 0.03). There was no other disease or associated condition such as chronic renal failure or high-dose steroid treatment concomitant with the development of Jaccoud's syndrome. It may be concluded that in patients with overlap syndrome, Jaccoud' arthropathy seems to be more frequent in patients who meet criteria for SLE.

Linear scleroderma and melorheostosis: case presentation and literature review.

The case of a 9 year-old male patient with linear scleroderma and melorheostosis of the iliac bone is described. Radiological findings suggestive of osteopoikilosis were found in carpal and tarsal bones. A review of the literature on this unusual disease association is made.

Apatite deposition in polymyositis subluxing arthropathy.

We describe a 47-year-old woman who developed chronic subluxing arthropathy associated with polymyositis (PM) and positive anti-Jo1 antibodies. After a followup of 3 years, PM did not recur and polyarthritis dominated her clinical picture, leading to deformities and periarticular calcifications in her hands, shoulders, and feet. Patients with myositis, anti-Jo1 antibodies, and periarticular calcifications are at risk of developing deforming arthritis unresponsive to conventional therapy.

Neurological features in overlap syndrome.

We report the frequency of neurological findings in 33 patients with overlap syndrome and describe 2 patients presenting unusual neurological involvement. Five of the 33 patients (15%) had one or more neurological findings. Unilateral trigeminal sensory neuropathy was presents, in 4 patients, in 3 of whom this was the only neurological feature. In the other patient it was associated with other manifestations of central as well as peripheral nervous system involvement, with an overall clinical pattern highly suggestive of a demyelinating disorder. The fifth patient, after an aseptic meningitis-like illness, developed a slowly progressive paraparesis, likewise pointing to a demyelinating disease. Our findings suggest that neurological manifestations, mainly trigeminal neuropathy, are frequent features in overlap syndrome; occasionally, central nervous system involvement mimicking a demyelinating disease may also be observed.

Lymphadenopathy secondary to silicone hand joint prostheses.

The occurrence of lymphadenopathies was investigated in 23 patients with diverse rheumatic conditions who had silastic prosthesis in joints of the hands, to determine whether these adenopathies were due to the presence of silicone particles. Five cases had clinically detectable lymph node enlargement and tissue samples were studied by light and scanning electron microscopy (SEM) and energy dispersive X-ray analysis (EDXA). In 3 out of the 5 cases foreign body granulomas were observed by light microscopy, SEM showing a highly irregular distribution of foreign body material with a peak for silicone by EDXA. Foreign body particle distribution closely correlated with silicone concentration. No granulomas were found in the two remaining patients with adenopathies who presented a non-specific reactive lymphadenitis. Our findings show that silicone lymphadenopathy is a more frequent complication (13%) of silastic arthroplasty than is usually recognized and therefore should be considered in the differential diagnosis of patients with lymph node enlargement who have previously received a silicone arthroplasty.

Clinical and serologic characteristics of patients with overlap syndrome: is mixed connective tissue disease a distinct clinical entity?

We discuss the clinical and serologic features of 27 patients with overlap syndrome followed prospectively by our group. The findings are similar to those of other reports, but we have drawn attention to the presence of peritendinous nodules in these patients and mentioned some peculiar neurologic manifestations. Rheumatoid arthritis was the most common diagnosis in our patients. The presence of high-titer antibodies against the nuclear ribonucleoprotein fraction of extractable nuclear antigen (nRNP) did not allow the identification of a particular subgroup. However, patients with this antibody tended to fulfill more criteria of more diseases than those without it. The findings lead us to conclude that antibodies to nRNP do not identify a particular subgroup within the overlap syndromes and that mixed connective tissue disease does not appear to be a distinct entity.