La representación social de cuidadores de niños y adolescentes con parálisis cerebral hemipléjica / Social representations of caregivers of children and adolescents suffering from hemiplegic cerebral palsy

El objetivo de este estudio ha sido evaluar la representación social de los padres/cuidadores de niños y/o adolescentes con parálisis cerebral hemipléjica, a partir de la “Escala de Evaluación de la Implicancia Familiar” en los pacientes en rehabilitación y un protocolo con preguntas abiertas y cerradas. El análisis cuantitativo se realizó con estadística descriptiva y el análisis cualitativo a través de análisis de contenido. Se evaluaron 24 niños y/o adolescentes y sus cuidadores. Los cuidadores son mujeres de bajos ingresos, baja escolaridad y formación profesional. La representación social de estas cuidadoras, en cuanto al rendimiento motor, la participación escolar y social de sus hijos, tiene la expectativa de un patrón normal y sentimientos ambiguos sobre el proceso de rehabilitación.

La representación social de cuidadores de niños y adolescentes con parálisis cerebral hemipléjica / Social representations of caregivers of children and adolescents suffering from hemiplegic cerebral palsy

El objetivo de este estudio ha sido evaluar la representación social de los padres/cuidadores de niños y/o adolescentes con parálisis cerebral hemipléjica, a partir de la ôEscala de Evaluación de la Implicancia Familiarö en los pacientes en rehabilitación y un protocolo con preguntas abiertas y cerradas. El análisis cuantitativo se realizó con estadística descriptiva y el análisis cualitativo a través de análisis de contenido. Se evaluaron 24 niños y/o adolescentes y sus cuidadores. Los cuidadores son mujeres de bajos ingresos, baja escolaridad y formación profesional. La representación social de estas cuidadoras, en cuanto al rendimiento motor, la participación escolar y social de sus hijos, tiene la expectativa de un patrón normal y sentimientos ambiguos sobre el proceso de rehabilitación. (AU)

La representación social de cuidadores de niños y adolescentes con parálisis cerebral hemipléjica / Social representations of caregivers of children and adolescents suffering from hemiplegic cerebral palsy

El objetivo de este estudio ha sido evaluar la representación social de los padres/cuidadores de niños y/o adolescentes con parálisis cerebral hemipléjica, a partir de la ôEscala de Evaluación de la Implicancia Familiarö en los pacientes en rehabilitación y un protocolo con preguntas abiertas y cerradas. El análisis cuantitativo se realizó con estadística descriptiva y el análisis cualitativo a través de análisis de contenido. Se evaluaron 24 niños y/o adolescentes y sus cuidadores. Los cuidadores son mujeres de bajos ingresos, baja escolaridad y formación profesional. La representación social de estas cuidadoras, en cuanto al rendimiento motor, la participación escolar y social de sus hijos, tiene la expectativa de un patrón normal y sentimientos ambiguos sobre el proceso de rehabilitación. (AU)

Neoplasias associadas ao carcinoma epidermóide do esôfago / Neoplasms associated to esophageal epidermoid carcinoma

INTRODUÇÄO. O carcinoma epidermóide de esôfago (CEE) tem uma importante associaçäo com neoplasias do trato aerodigestivo e, provavelmente, compartilham dos mesmos fatores de risco. Além destes, outras neoplasias podem estar associadas com o carcinoma de esôfago. OBJETIVO. Analisar, retrospectivamente, pacientes com carcinoma epidermóide de esôfago tratados pelo Grupo de Cirurgia do Esôfago, Estômago e Intestino Delgado (GCEEID) do Hospital de Clínicas de Porto Alegre (HCPA), no período de janeiro/88 a junho/95, os quais tinham neoplasias associadas ao CEE. PACIENTES E MÉTODOS. Dentre os 261 pacientes estudados, 19 (7,28 por cento) tinham neoplasia associada ao CEE. Dez pacientes apresentaram tumores sincrônicos e 9, metacrônicos. O sexo predominante foi o masculino, com 17 casos. A média de idade ficou em 62,52 anos no momento do diagnóstico da neoplasia esofágica. RESULTADOS. Os tumores aerodigestivos, na sua totalidade carcinomas escamosos, representaram o tipo histológico predominante da neoplasia associada em 68,42 por cento dos casos. O sítio mais freqüente da neoplasia aerodigestiva associada foi a árvore respiratória (53,8 por cento), seguido da cavidade oral e orofaringe (23 por cento) e laringe (23 por cento). Dos 19 pacientes, 12 eram tabagistas e nove ingeriam bebidas alcoólicas regularmente. Para o tratamento do CEE, optou-se por cirurgia em seis pacientes. A neoplasia associada foi tratada com cirurgia radical em 11 pacientes e radioterapia em cinco. Surpreendentemente, foram diagnosticados quatro casos (21 por cento) de adenocarcinomas gßstricos associados ao CEE, tratados com cirurgia radical em três pacientes. CONCLUSÄO. Os autores ressaltam a importância do estadiamento criterioso dos pacientes com CEE devido a associaçäo significativa com outras neoplasias, principalmente com tumores aerodigestivos. Alertam para o seguimento desses pacientes e discutem a possibilidade de fatores de risco comuns: fumo e álcool. Nesta casuística, encontrou-se associaçäo importante com neoplasias gástricas.

From the foot-mouth reflex to the hand-mouth reflex. A continuum of responses to appendicular compression.

We studied the mouth opening response to appendicular compression in two groups of children. This study was performed with the intention of testing the semiologic role of the act of mouth opening following stimulation of various regions, based on the hand mouth reflex of Babkin. Group I was formed by 33 normal children who underwent monthly follow up assessments since birth; and group II consisted of 50 children older than 6 months of age, known to have a neurologic deficit and a neuro-psychomotor development equivalent to that of a child in the first trimester of life. We observed that the normal mouth opening response in group I was more pronounced following compression of the hand and forearm when compared to compression of the arm (p < 0.001). This response could persist for as long as the first 6 months of life. We were not able to elicit a mouth opening response following compression of the lower limb in this group. Among children from group II, we observed mouth opening responses to stimulation of all limb segments. Within the upper limb, the response was more pronounced following compression of the hand in comparison to the forearm (p < 0.01), and forearm in comparison to the proximal arm (p < 0.01). Stimulation of the foot was more effective in eliciting a mouth opening response when compared to equivalent stimulation of the lower leg (p < 0.05). However, there was no statistical difference when responses to stimulation of the lower leg and thigh were compared. The presence of the previously unreported foot-mouth response may serve as an indicator of central nervous system compromise and could be associated with a poorer prognosis. We believe that our observations of the specific foot-mouth response patterns may serve as a marker of early neuro-psychomotor development dysfunction during childhood.

[Characterization of mitochondrial myopathies through the evaluation of the enzymatic activities involved in energy metabolism]. / Caracterização de miopatias mitocondriais através da avaliação das atividades enzimáticas envolvidas no metabolismo energético.

The activities of the enzymes NADH dehydrogenase, NADH cytochrome e reductase, succinate dehydrogenase, succinate cytochrome e reductase, cytochrome c oxidase and citrate synthase in normal and sick human skeletal muscle mitochondria were determined. A control group was formed by 13 normal people and without using continuous medication. The patient group was formed by 10 people whose pathological diagnosis indicated suspicion of mitochondrial myopathy. A decrease in the activity of the enzymes in all patient was observed: 7 with abnormality in all the tested enzymes; 2 with deficiencies in all the enzymes except cytochrome e oxidase; and 1 with dysfunction only in the activities of succinate dehydrogenase and succinate cytochrome e reductase. The results indicate multiple or combined deficiencies in the respiratory chain, besides dysfunction of citrate synthase in 9 patients. In one exceptional case, the enzymatic deficiency was restricted to complex II. It is possible to conclude that the methodology used herein is adequate and easily applicable to clinical objectives, and that the results obtained allow characterization of the deficient mitochondrial enzymatic complexes, thus showing that the origin of the diseases is an energetic metabolic dysfunction.

[Neoplasms associated with esophageal epidermoid carcinoma]. / Neoplasias associadas ao carcinoma epidermóide do esôfago.

INTRODUCTION: The esophageal epidermoid cancer has an important association with aerodigestive tract neoplasms and possibly share the same risk factors. Furthermore, other neoplasms can be associated with esophagus cancer. OBJECTIVE: To analyze retrospectively the patients with esophageal epidermoid cancer (EEC) and associated neoplasms, treated by the Esophagus Stomach and Small Intestine Group of Surgery at Hospital de Clinicas de Porto Alegre from January 1988 to June 1995. PATIENTS AND METHODS: Nineteen (7.28%) of the 261 studied patients had associated neoplasms to the EEC. Ten patients presented synchronic tumours and 9 metachronic ones. The predominant sex was the masculine with 17 cases. The mean age was 62.52 years in the moment of the esophageal cancer diagnostic. RESULTS: The aerodigestive tumours, squamous carcinomas in totality, represented the predominant associated neoplasm histological type in 68.42% of the cases. The most frequent associated aerodigestive tumours site was the respiratory tract (53.8%), followed by the oral cavity and oropharynx (23%) and larynx (23%). In our sample, twelve patients were smokers and 9 were alcohol abusers. In relation to the EEC treatment, surgery was performed in 6 patients. The associated neoplasm was treated with radical surgery in 11 patients and radiotherapy in 5. Surprisingly 4 cases (21%) of gastric adenocarcinoma associated to the EEC were diagnosed, treated with radical surgery in 3 patients. CONCLUSION: The authors call attention to the importance of a criterial staging as well as the follow up in patients with EEC owing to the significant association with others neoplasms, principally with aerodigestive tumours, and discuss the common risk factors possibility: tobacco and alcohol use. Important association with gastric neoplasms were found in this casuistry.

Vigabatrin in refractory childhood epilepsy. The Brazilian Multicenter Study.

Children, 47, with various types of severe drug-resistant epilepsy were entered into a prospective, add-on, open trial with vigabatrin. Patients with West syndrome and idiopathic generalized epilepsies were excluded. Seven children had the drug withdrawn, five because of increase in seizure frequency and two because of adverse effects. Drug efficacy, measured according to seizure type, showed a 100% decrease in seizure frequency in 18.6% of partial seizures and 17.3% of the generalized seizures. There was a higher than 50% decrease in 39.5% of partial and 60.8% of generalized seizures, and less than 50% decrease or increase in seizure frequency in 41.8% and 21.8% of partial and generalized seizures, respectively. Vigabatrin mean dosage during phase 3 was 63.6 mg/kg per day (S.D. = 30.5), ranging from 19.3 to 110.5 mg/kg per day. Parametric statistical analysis (Student's t-test) of seizure frequency between phases 1 and 3 showed a significant decrease in seizure frequency for partial (P = 0.022), and generalized seizures (P < 0.0001). Drug-related adverse effects were observed in 18/47 cases (38.3%), consisting mainly of irritability, hyperactivity, dizziness, somnolence and gastrointestinal symptoms.

Parada cardiaca anoxica hipotermica (20 graus) e alteracoes enzimaticas mitocondriais. / Anoxic hypothermic (20 degrees) heart arrest and mitochondrial enzymatic changes

Foram estudados 24 caes distribuidos nos seguintes grupos: Grupo I - Oito animais, cujos coracoes foram estudados imediatamente apos anestesia e toratocomia (controle).Grupo II Oito animais submetidos a 60 minutos de parada cardiaca anoxica normotermica. Grupo III Oito animais submetidos a 60 minutos de parada cardiaca anoxica hipotermica (20 graus).Os resultados obtidos possibilitaram as seguintes conclusoes: A) O esfriamento seletivo do miocardio impediu a diminuicao das concentracoes de ATP. B) As alteracoes nos sistemas enzimaticos estudados (alfa-ceco-glutario-desidrogenase: succino-desidrogenase; beta-hidroxi-butirico-desidrogenase; glutamico-desidrogenase e malico-desidrogenase), determinadas pela parada anoxica normotermica, excetuando-se o controle da beta-hidroxi-butiricodesidrogenase, nao foram prevenidas pelo esfriamento do miocardio a 20 graus C

The effect of food deprivation on the activities of some enzymes of the metabolism of carbohydrates in the submandibular salivary glands of rats.

Male albino rats of the Wistar strain were deprived of food, but not water, and killed at various periods. Enzymes of the metabolism of carbohydrates were assayed in the submandibular salivary glands after 24, 48, 72, 96 and 120 hours of starvation. The body weight loss was accompanied by a decrease in gland weight and gland protein content. Blood glucose fells to about 70% the control level. Hexokinase showed no variation with increasing periods of food deprivation. The decrease in the activity of phosphofructokinase was greater than that one observed for glucose-6-phosphate dehydrogenase, indicating a shift in glucose utilization by the cells, from the glycolytic to the pentose phosphate pathway.