Peculiarities of Morphology of Large Salivary Glands in Experimental Animals Under Different Conditions of Motor Activity of Their Mothers During Pregnancy

Objective: To evaluate of the microstructure of the salivary glands of experimental animals born from of females rats, who were subjected to different modes of motor activity during the pregnancy: limited and compensated by regular moderate training. Material and Methods: The sample was composed 84 three-month-old descendants of Wistar rats which were divided into three groups: G1 (n = 27): posterity of female rats, who during gestation were in standard conditions; G2 (n = 25): posterity of female rats, who during pregnancy were in hypokinesia conditions; G3 (n = 32): which stayed in conditions of hypokinesia, but had running load in running wheel regularly 5 times a week. Results: In adult descendants of G2, morphological structure of the submandibular salivary glands was characterized by decrease size and number of glandular cells; reduction of their cytoplasm; increase in heterochromatin amount and decrease in the intensity of fuchsinophilia. Microstructure of the submandibular salivary glands of the offspring of G3 indicates positive effect of regular short-term physical activity on the morphofunctional state of the specified glands. An increased number of tissue basophils in their stroma is also in favor of greater functional activity of salivary glands. Conclusion: This study indicates deceleration of the metabolic processes in salivary glands of animals under the influence of hypokinesia of their mothers during pregnancy. It was also confirmed that regular physical activity completely eliminates the negative effect of mothers' hypokinesia on morphology the salivary glands of the descendant.

Efeito da técnica de sobrearticulação na voz e na fala em indivíduos com doença de Parkinson após cirurgia de estimulação cerebral profunda / Effect of overarticulation technique in voice and speech of individuals with Parkinson's disease with deep brain stimulation

RESUMO Objetivo Verificar o efeito imediato e após 15 minutos da técnica de sobrearticulação de fala em indivíduos com doença de Parkinson, submetidos à estimulação cerebral profunda em núcleo subtalâmico, nos parâmetros de voz, fala e mímica facial. Métodos Participaram 29 sujeitos com diagnóstico médico de doença de Parkinson, sob tratamento medicamentoso e submetidos à estimulação cerebral profunda em núcleo subtalâmico, com e sem reabilitação fonoaudiológica prévia. Realizou-se gravação em áudio e vídeo de amostra de fala e voz em três momentos: pré-intervenção, pós-imediato e após 15 minutos da realização individual de cinco minutos de uma sequência de exercícios de sobrearticulação de fala. As gravações foram submetidas à avaliação perceptivo-auditiva da voz e perceptivo-visual da mímica facial. Resultados A técnica produziu resultados positivos em 69% dos casos, após 15 minutos de aplicação, em relação aos demais momentos. O parâmetro que mais contribuiu para a identificação da melhor emissão na avaliação perceptivo-auditiva foi articulação (69%), significativamente maior que os demais parâmetros, exceto velocidade de fala. A análise perceptivo-visual mostrou melhora em 58,6% dos casos após 15 minutos, também significativamente melhor que os demais momentos. O parâmetro em que se observou maior proporção de melhora foi na movimentação de boca, sobrancelhas e olhos. Conclusão A técnica de sobrearticulação de fala produz efeito positivo imediato nos aspectos vocais e uma maior expressividade facial, principalmente após 15 minutos de realização.

ABSTRACT Purpose To verify the immediate and after 15 minutes effect of the overarticulation technique in individuals with Parkinson's disease, submitted to deep brain stimulation in subthalamic nucleus, in the voice, speech and facial movements. Methods This study counted with 29 patients with the diagnosis of Parkinson Disease who were undergoing pharmacotherapy and were submitted to deep brain stimulation in the subthalamic nucleus, with and without prior speech therapy. Speech and voice samples were recorded in an audio and video file at three different moments: pre-intervention, immediate post intervention and 15 minutes post intervention. The intervention was the individual performance of 5 minutes exercise consisting of sequence of overarticulation techniques. The audio and video recordings were submitted to the perceptual-judgement of the voice quality and facial movements. Results The technique produced positive results in 69% of the cases after 15 minutes of its application when compared to the other moments. Articulation was the parameter that most contributed in the perceptual-judgment of the best voice quality (69%); it was significantly higher than the other parameters, except speech rate. After 15 minutes of the technique, 58.6% of the patients had improvement in the facial movements, according to the perceptual-judgment which was also significantly better when compared to other moments. The parameter with greater provement was movement of the mouth, eyebrows and eyes. Conclusion The overarticulation technique produces an immediate positive effect on vocal aspects and greater facial expressiveness, especially after 15 minutes.

Bereitschaftspotential preceding eyelid blinks in Parkinson's disease / Potencial de Bereitschafts precedendo o piscamento ocular na doença de Parkinson

ABSTRACT The Bereitschaftspotential (BP) is a negative wave observed in EEG retrograde averaging, preceding a motor act. The objective was to study the BP preceding voluntary eyelid blinks in Parkinson's disease (PD) patients during off and on phases of levodopa. Methods Ten PD patients in stages 1 and 2 of the Hoehn & Yahr classification were compared to 18 healthy controls. Artifact-free EEG segments of two seconds preceding the onset of the blink potential were averaged and analyzed, and the statistical significance of the measured amplitudes were evaluated by analysis of variance models. Results The presence of a BP in the PD patients was demonstrated. The mean amplitudes at 0 ms were respectively 0.6 µV and 3.3 µV for the BP patients and the normal controls, respectively. Conclusions The BP amplitudes were significantly smaller in PD patients than normal participants. The amplitudes of the BP were not modified by levodopa.

RESUMO O Potencial de Bereitschafts (PB) é uma onda negativa observada retrogradamente no EEG precedendo um ato motor. Objetivo Estudar o PB precedendo o piscamento palpebral voluntário em pacientes com doença de Parkinson (DP) durante as fases off e on da levodopa. Foram comparados dez pacientes com DP nos estágios 1 e 2 de Hoehn & Yahr com 18 controles saudáveis. Os segmentos de EEG livres de artefatos 2 segundos antes do início do potencial foram calculados e analisados e a significância estatística das amplitudes foi medida por modelos de análise de variância. Resultados A presença de PB nos pacientes com DP foi demonstrada. As amplitudes médias a 0 ms foram respectivamente 0,6 μV e 3,3 μV para os pacientes com DP e controles respectivamente. Conclusões As amplitudes do PB foram significativamente menores nos pacientes com DP do que controles. As amplitudes do PB não foram modificadas pela levodopa.

TeleCondutas: tremor e síndromes parkinsonianas / TeleGuides: tremor and parkinsonian syndromes

As principais causas de tremor em pacientes atendidos na Atenção Primária à Saúde são: exacerbação de tremor fisiológico, tremor essencial (acomete 5% da população acima de 40 anos) e as síndromes parkinsonianas. É importante definir corretamente sua origem, pois o tratamento e o prognóstico são variados. Esta guia apresenta informação que orienta a conduta para casos de tremor e síndromes parkinsonianas no contexto da Atenção Primária à Saúde, incluindo: etiologia do tremor e síndromes parkinsonianas, avaliação clínica, tipos de tremor, sintomas cardinais de parkinsonismo, medicamentos indutores, fluxograma de avaliação do tremor, exames complementares, tratamento do tremor essencial e doença de parkinson, encaminhamento para serviço especializado.

Unusual motor and non-motor symptoms and signs in the early stage of Parkinson's disease / Sintomas e sinais motores e não motores pouco comuns na fase inicial da doença de Parkinson

ABSTRACT Objective Patients with Parkinson’s disease (PD) may present with unusual motor and non-motor symptoms and signs in the early stage of the disease. Methods Cases were collected over a five-year period at two tertiary movement disorders clinics. All had a diagnosis of PD with unusual presentations defined retrospectively as the presence of complaints not objectively related to any of the classic cardinal signs of parkinsonism or the typical early non-motor features of PD. Results A total of 15 early PD patients fulfilled the proposed criteria, presenting with symptoms such as atypical tremors, shoulder pain, signs related to the rigid akinetic syndrome, as well as cases of asthenia, rhinorrhea, parosmia, dysgeusia, nocturnal sialorrhea, and color discrimination disorders. Conclusions Unusual motor and non-motor symptoms and signs in the early stage of PD can be difficult to interpret. Specialists should be aware of these conditions as clues to a potential diagnosis.

RESUMO Objetivo Pacientes com doença de Parkinson (DP) podem apresentar sintomas e sinais motores e não motores pouco comuns na fase inicial da doença. Métodos Os casos foram coletados em um período de cinco anos, em dois centros terciários de distúrbios do Movimento. Todos os pacientes tinham o diagnóstico de DP com apresentações clínicas iniciais pouco comuns. Resultados Um total de 15 pacientes com DP na fase inicial, apresentando sintomas e sinais tais como, tremores atípicos, dor no ombro, sinais relacionados com a síndrome rígido-acinética, bem como casos com astenia, rinorréia, parosmia, disgeusia, sialorréia noturna e distúrbios da discriminação de cores. Conclusões Sintomas e sinais motores e não motores pouco comuns na fase inicial da DP podem ser de difícil interpretação. Neurologistas devem estar a par destas condições, como pistas para o potencial diagnóstico.

Effect of adenosine A2A receptor antagonists on motor disorders induced by 6-hydroxydopamine in rat

PURPOSE: To investigate the role of adenosine A2A receptors on 6-OHDA-induced motor disorder in rat. METHODS: In order to induce experimental model of Parkinson's disease, 6-hydoxydopamine (8 μg/rat) was injected unilaterally into the SNc. After three weeks as a recovery period, 6-OHDA-induced bradykinesia and balance disturbances were assessed by using beam traversal test 10, 30 and 60 minutes after intraperitoneal injections of the drugs (caffeine, SCH58261). RESULTS: The results showed that 6-OHDA (8 μg/rat, Intra-SNc) induced motor disorders of Parkinson's disease and increased elapsed time in the beam test (p<0.001). Injection of caffeine (30 mg/kg, i.p.) and SCH58261 (2 mg/kg, i.p.) attenuated elapsed time on beam (p<0.01 and p<0.001). We showed that acute administration of caffeine and SCH 58261 can improve the 6-OHDA-induced bradykinesia and motor disturbance. CONCLUSION: Adenosine A2AR antagonists improve 6-OHDA-motor deficit and this effect seems to be mediated by the inhibition of A2A presynaptic receptors in substantia nigra pars compacta.

Avaliação quantitativa dos efeitos da levodopa e da estimulação do núcleo subtalâmico sobre o equilíbrio em pacientes com doença de Parkinson / Quantitative evaluation of the effects of levodopa and bilateral subthalamic stimulation on postural control in patients with Parkinson´s disease

INTRODUÇÃO: Os efeitos da levodopa (LD) e da estimulação cerebral profunda (ECP) de núcleo subtalâmico (STN) sobre o equilíbrio e sintomas axiais são até o momento controversos. OBJETIVOS: Avaliar quantitativamente os efeitos da ECP de STN e da LD sobre o equilíbrio estático em pacientes com DP operados, em comparação com a LD em pacientes não operados. MÉTODOS: Trinta e um pacientes submetidos a ECP de STN entre 3 meses e 1 ano e meio antes da avaliação e 26 controles portadores de DP não operados, estágios Hoehn e Yahr 2 a 4 foram avaliados usando UPDRS para avaliação clínica e plataforma de força para avaliar oscilações posturais. O primeiro grupo foi avaliado com ECP e sem medicação, com ECP e com medicação e sem ECP e sem medicação. O segundo grupo foi avaliado com e sem medicação. Cada paciente foi avaliado com os olhos abertos e fechados. O deslocamento do centro de pressão anteroposterior, laterolateral, a área, velocidade e deslocamento total linear foram medidos pela plataforma de força. Os dados paramétricos foram comparados usando o teste t de Student e os dados não-paramétricos foram comparados pelo teste de Kruskal-Wallis. A avaliação clínica consistiu na parte 3 da escala UPDRS e na escala Hoehn e Yahr. Nível de significância estatística considerada foi p=0,05. RESULTADOS: Os pacientes não operados oscilaram mais quando sob efeito da levodopa do que sem medicação. No grupo operado, a maior oscilação é no grupo com ECP desligada e sem medicação. Tende a reduzir sob efeito da ECP apresenta redução significativa sob efeito simultâneo de ECP e levodopa. CONCLUSÃO: A associação da ECP de NST com medicação tem impacto positivo sobre o controle postural. O efeito da ECP de NST reverte o efeito negativo da levodopa sobre as oscilações observadas em pacientes não operados.

INTRODUCTION: The effects of bilateral subthalamic (STN) DBS and medication on balance and on axial symptoms in PD have been so far inconsistent. OBJECTIVE: To assess quantitatively the effects of DBS on static balance in PD. METHODS: Thirty-one patients submitted to STN DBS over 3 months before and 26 non-operated controls with PD on Hoehn & Yahr stage "on" 2 to 4 were evaluated using UPDRS and a force plate to measure sway. The first group was evaluated on-DBS/off-medication, on-DBS/on-medication and off-DBS/off-medication. The second group was evaluated on and off medication. Each group was assessed with eyes open and then closed. Antero-posterior, laterolateral postural displacements of the center of pressure (COP), as well as 95% sway area, path length and speed of oscillation were analyzed and compared using t-Student test for parametrical data and Kruskal-Wallis test for non-parametrical data. Level of significance was set to p < 0.05. Clinical assessment consisted of UPDRS part 3 and Hoehn & Yahr scores for each of the conditions. RESULTS: Control patients tended to oscillate more in the on medication condition than off medication. DBS patients tended to oscillate more in the off-DBS/off medication condition, with a tendency to decrease the sway when on DBS/off medication with additional decrease when on DBS/on medication. CONCLUSION: Association of bilateral STN DBS and medication positively influences postural control in PD and surgery reverses the tendency of medication to increase body sway in non-operated patients.

Care interventions in the elderly with stasis syndrome: a clinical essay

Object: Losses in functional capacity of upper limbs of elders confined to bed may be due to the fracture of the femur. Aims: To perform a systematic review of the literature regarding the Stasis Syndrome; to elaborate, according to a previous analysis, an intervention proposal involving multidisciplinary care, to alleviate the effects of the Stasis Syndrome; to verify the effect of this multidisciplinary protocol of intervention according to the biological variables of elders with Stasis Syndrome through the use of an instrument created for this purpose. Method: This is controlled clinical research, with a quantitative approach. It involves the use of quantification during and treatment of patients and the associated data collection, through statistical techniques and the use of specific software...

Parámetros cinemáticos en la prueba de Tapping en pacientes con enfermedad de Parkinson / Cinematic parameters in the Tapping test in patients with Parkinson's disease

Motor slowness is the most characteristic motor deficit in Parkinson Disease (PD). The tapping test is a timed motor performance task which has been widely used in evaluation of PD. We study kinematics parameters of tapping test in PD and health control. Methods: Subjects consisted on 12 patients (2 women) with Parkinson's disease (PD) and 6 healthy control subjects (2 women). The mean age 63 +/- 9.7years PD and 64.8 +/- 13.3 years control. Duration of disease was 5.8 +/- 4.1 years. All patients were on levodopa medication. Procedures: All participants performed repetitive Hand/Arm movements between two points placed 25 cm apart horizontally for 20 successive taps ("as fast as possible"). The test was performed independently for each hand. Parkinson patients performed under the best ON condition. We assessed patients clinically using the motor section of the Unified Parkinson Disease Rating Scale (UPDRS). Informed consent was obtained. Apparatus: One standard video camera positioned perpendicularly from two target points recorded movement and referential xy system. A light reflective marker was attached to middle finger. The middle finger marker was manually digitized at a rate of 30 Hz using Kinematics Analysis software. Statistical analysis Kuskal-wallis one way analysis of variance, r spearman correlation. A p value < 0.05 was considered statistically significant. Results: Median Velocity in normal control was 94 +/- 11 cm/s and in PD was 67 +/- 15 cm/s (p < 0.001). Maximal velocity in normal control was 198 +/- 20 cm/s and in PD was 143 +/- 33 cm/s (p < 0.001). Median acceleration in normal control was 1630 +/- 331 cm/s2 in PD was 966 +/- 285 cm/s2 (p < 0.001). Median Movement amplitude in Y plane; in normal control was 28 +/- 5 cm and in PD was 21 +/- 8 cm (p < 0.01). Median Movement amplitude in Y plane correlated significantly with bradykinesia summary score (r = -0.59, p < 0.001)...

La bradicinecia es el déficit motor más característico de la enfermedad de Parkinson (EP), generalmente diagnosticado bajo diversos estudios como la prueba de tapping -ampliamente utilizada para determinar la enfermedad-, donde se mide la repetición de una tarea específica en un tiempo determinado. En el siguiente trabajo se estudiaron los parámetros cinemáticos del tapping en EP y controles. El estudio se realizó en 12 pacientes con EP con una edad media de 64,6 +/- 9,4 años -con duración promedio de la EP de 5,8 +/- 4,1 años. Todos los casos estaban en tratamiento con levodopa. Además, se estudiaron 7 controles en personas con una edad media de 64,8 +/- 12,8 años. Se les solicitó a todos que con los dedos de la mano tocaran en forma secuencial dos puntos separados por 25 cm. En el dedo medio se instaló una marca refractaria a la luz, utilizada como referencia para determinar la posición de la mano. El movimiento fue filmado mediante una cámara de video estándar con una velocidad de 30 cuadros por segundo. Los pacientes fueron evaluados clínicamente usando la escala unificada para la valoración de la enfermedad de Parkinson en su sección motora parte III (UPDRS-III). El análisis cinemático se realizó mediante un software especialmente diseñado para determinar la posición espacial de la marca en relación al sistema de referencia cartesiano. El análisis estadístico se realizó con Kurskal-Wallis test y correlaciones de Spearman. Se consideró significación estadística con p < 0,05. Resultados: La velocidad media en el control normal fue de 94 +/- 11 cm/seg y en la EP fue de 67 +/- 15 cm/seg (p <0,001). La velocidad máxima en el control normal fue de 198 +/- 20 cm /seg y en la EP fue de 143 +/- 33 cm/seg (p < 0,001). En el control de aceleración media normal fue 1.630 +/- 331 cm/seg² en la EP fue 966 +/- 285 cm/seg² (p < 0,001). Movimiento amplitud media en el plano Y, en el control normal fue de 28 +/- 5 cm y en la EP fue de 21 +/- 8 cm (p < 0,01)...

Hipertensión arterial pulmonar por ecocardiografía en pacientes con enfermedades de tejido conectivo / Pulmonary hypertension associated with connective tissue diseases

Background: Pulmonary arterial hypertension is an important cause ofcomplica-tions amongpatients with connective tissue diseases. Aim: To describe the clinical and echocardiographic characteristics ofpatients with pulmonary hypertension associated with connective tissue diseases. Material and Methods: Retrospective, observational and descriptive study. We analyzed 35 patients with pulmonary hypertension associated with connective tissue diseases. All patients were evaluated and diagnosed by at least one medical specialist in rheumatology. Pulmonary arterial hypertension was defined as a pulmonary artery systolic pressure ≥ 40 mmHg by echocardiography. The group was divided as not severe when pressures ranged from 40 to 64 mmHg and severe, when pressures were ≥ 65 mmHg. Results: The most common connective tissue disease associated with pulmonary arterial hypertension was diffuse scleroderma in 46% of cases. Eighty nine percent of patients were female. Time of evolution of the pulmonary hypertension was 18.8 ± 21.8 months. The distance walked in the six minute walk test was < 400 m both in patients with and without severe pulmonary hypertension. Fifty one percent ofpatients had pulmonary restriction. No differences in gas exchange parameters were observed between groups. Comparing echocardio-graphic findings in patients with and without severe hypertension, the former had a higher frequency ofright ventricular dilatation (85.7 and 52.3% respectively, p = 0.04), right ventricular hypertrophy (42.8 and 0% respectively, p = 0.02) and right ventricular hypokinesia (71.4 and 9.5% respectively p = < 0.01). Conclusions: Patients with severe pulmonary arterial hypertension associated to connective tissue diseases have more commonly dilated, hypertrophic and hypokinetic right ventricles.

Achados de ultrassonografia transcraniana na doença de Parkinson e no tremor essencial: relato de casos / Transcranial sonography findings in Parkinson's disease and essential tremor: cases report

A ultrassonografia transcraniana tem sido objeto de investigação como ferramenta diagnóstica em neurologia nos últimos anos. Ela permite boa visualização de estruturas cerebrais situadas na linha média, sítio frequente de anormalidades nas doenças do movimento. Relatamos os casos de pacientes com a doença de Parkinson e o tremor essencial em que a ultrassonografia transcraniana foi capaz de sugerir o diagnóstico.

Over the last years, transcranial sonography has been investigated as a diagnostic tool in neurology. It allows a good visualization of midline brain structures, a frequent site of involvement in movement disorders. The authors discuss cases of Parkinson's disease and essential tremor where transcranial sonography could suggest the diagnosis of the condition.

Síntomas no motores en pacientes con enfermedad de parkinson. Hospital de San José, Bogotá, DC Colombia / Non-motor symptoms in parkinson disease patients Hospital de San José, Bogotá DC. Colombia

La enfermedad de Parkinson (EP) es la segunda afección neurodegenerativa en frecuencia con una prevalencia en Colombia de 4.7 por mil habitantes. Los síntomas no motores (SNM) hacen parte del espectro ya que generan un aumento de la morbilidad e impactan la calidad de vida. Objetivo general: describir la frecuencia de SNM en pacientes con EP que asisten a la consulta externa de neurología en el Hospital de San José de Bogotá DC. Métodos: serie de adultos que consultaron entre abril y septiembre de 2011 cumpliendo criterios diagnósticos de EP según UK Brain Data Bank. Se utilizó el cuestionario de SNM para EP, PD NMS quest, validado en español. Resultados: se encuestaron 55 pacientes con edad promedio de 68 años (DE 9.8), hombres 61.8%. El 51%, con un tiempo de evolución menor o igual a cinco años. El 85.5% tenían una puntuación en escala de Hoehn y Yahr entre I-II. Los SNM más frecuentes son urgencia urinaria 76.4%, tristeza 74.5%, sensación desagradable en las piernas durante la noche o necesidad de moverlas 67.2% y problemas para recordar cosas 61.8%. Conclusiones: los SNM son frecuentes en nuestra población siendo el sistema urinario es el más comprometido. Se debe indagar sobre estos para brindar un manejo integral al paciente. Se requieren más estudios en nuestra población que evalúen el impacto sobre la calidad de vida.

Parkinson´s disease (PD) is the second most common neurodegenerative disorder with a prevalence of 4.7 per 1000 people in Colombia. Non-motor symptoms (NMS) are included in the spectrum for they lead to increased morbility and impaired quality of life. Overall Objective: to describe the frequency of NMS in patients diagnosed with PD who attend the neurology outpatient clinic at Hospital de San José de Bogotá DC. Methods: series of adults who consulted between April and September 2011 who met the diagnostic criteria for PD according to the UK Brain Data Bank. The PD NMS quest questionnaire validated in Spanish was used. Results: fifty-five patients, men 61.8%, average age 68 years (SD 9.8) were surveyed. A clinical course equal to or less than 5 years was documented in 51% Repert.med.

Alterações morfométricas em músculo respiratório de ratos submetidos à imobilização de pata / Morphometric alterations in respiratory muscle of rats submitted to paw immobilization

A imobilização é um recurso frequentemente utilizado na prática clínica, sendo comum em patologias álgicas e nas fraturas. O objetivo deste estudo foi analisar a influência do processo de imobilização em músculo do sistema respiratório, o diafragma. O experimento foi efetuado com 12 ratos Wistar machos divididos em dois grupos, controle e imobilizado. O procedimento de imobilização foi realizado através de um método alternativo de imobilização por fita adesiva, sendo mantida por duas semanas. Analisou-se a morfometria das fibras do diafragma com coloração de hematoxilina e eosina. Ao compararmos o diâmetro médio das fibras musculares do diafragma dos animais imobilizados (47,15μm ± 0,329μm) em relação ao controle (54,67μm ± 0,396μm), encontramos diferença estatística entre os grupos (p < 0,0001). Considerando os dados encontrados, foi possível concluir que a imobilização de pata, no modelo utilizado, foi capaz de gerar hipotrofia da musculatura respiratória, assim como um quadro geral de redução de massa corporal do animal.

Immobilization is a frequently used procedure in clinical practice and common in pain diseases and fractures. This study examined the influence of immobilization in a muscle-related respiratory system, the diaphragm. This experiment was conducted with twelve male rats divided into two groups, control and immobilized with an alternative method of restraining by tape, kept for two weeks. We analyzed the morphometry of the diaphragm muscle fibers with hematoxylin/eosin staining. Statistical difference was found (p < 0.0001) when the average diameter of the diaphragm muscle fibers of immobilized animals (47.15μm ± 0.329μm) was compared to the ones in the control group (54.67μm ± 0.396μm). Considering the results, it can be concluded that the immobilization of the animal paw in the used model was able to produce hypotrophy of respiratory musculature, as well as a general framework for reducing the mass of the animal.

La locura tensa / The tight madness

La catatonía es considerada un síndrome neuropsiquiátrico; su diagnóstico requiere de determinados síntomas y signos cardinales que incluyen alteraciones en el afecto y en la expresión voluntaria del pensamiento y de la conducta motora.Se intenta hacer un aporte a la clínica infanto-juvenil y a la terapéutica psicofarmacológica, a través de la presentación un caso clínico de una paciente de 17 años con retraso mental internada por un cuadro de catatonía, desencadenado tras episodios de abuso sexual. Se utiliza el material de la historia clínica para mostrar los diferentes aspectos clínicos de este cuadro y su respuesta terapéutica.A partir de su ingreso a la guardia, con un cuadro catatónico, se instala un abordaje multidisciplinario con un plan farmacológico que incluye benzodiazepinas, IRSS y un antipsicótico atípico. En la evolución, se aprecia una mejoría lenta y paulatina, tanto de los síntomas motores como afectivos. Al alta, permanecen síntomas residuales, principalmente cognitivos (retraso mental). El SPECT muestra alteraciones de la perfusión en diferentes áreas (disminución, aumento y asimetría). Los síntomas motores podrían explicarse por la alteración en la regulación GABAérgica de circuitos córtico-subcorticales (circuito motor, corteza motora/premotora con los ganglios basales). A su vez, es posible que la disfunción GABAérgica del circuito prefrontal-orbitofrontal explique los síntomas afectivos y comportamentales observados.Los factores psicosociales pueden actuar como desencadenantes del cuadro por estrés crónico. La asociación de benzodiazepinas, un IRSS y un antipsicótico atípico demostró ser útil en este caso grave.

Catatonia is considered a neuropsychiatric syndrome: its diagnosis requires certain cardinal signs and symptoms which include alterations in affect and expression of thought and voluntary motor behavoir. It tries to make a contribution to the clinical child/youth and psychopharmacological treatment through a clinical case of a 17 year old patient hospitalized with mental retardation by a catatonia syndrome triggered by repeated episodes of sexual abuse. It uses material from the clinical history to show the different aspect this condition and the therapeutic response. Since its entry into the guard with a catatonic syndrome, it installs a multidisciplinary approach with a drug plan in evolution, we see a slow and gradual improvement of both motor and affective symptoms. At dishcarge residual symptoms remains, mainly cognitive (mental retardation). The SPECT shows perfusion abnormalities in different areas (decrease, increase and asymmetry). Motor symptoms may be explained by the altered regulation of GABAergic cortico-subcortical circuits, especially those which connects the motor-premotor cortex with the basal ganglia. In turn, it is possible that GABAergic dysfunction in the prefrontal-orbitofrontal cortex circuit explain emotional and behavioral symptoms observed. Psychosocial factors may act as triggers of the illness by chronic emotional and behavioral symptoms observed. Psychosocial factors may act as triggers of the illness by chronic emotional and behavioral simptoms observed. The association of benzodiazepines, an SSRI and an atypical antipsychotic proved useful in this case serious.

Secuencia acinesia/hipocinesia fetal / Fetal Akinesia-Hipokinesia Sindrome

El síndrome de secuencia acinesia/hipocinesia fetal es un trastorno genético raro, descrito en 1974, por Pena y Shokeir, en dos hermanas que murieron al nacer con camptodactilia, pie equino, anquilosis de las rodillas y las caderas e hipoplasia pulmonar. Este síndrome afecta, aproximadamente a uno de cada 12.000 recién nacidos, y en la bibliografía médica se han reportado unos sesenta casos, los cuales en su mayoría son esporádicos. Además, buena parte de los casos familiares parece tener una herencia autosómica recesiva (25% de riesgo de recurrencia).Aunque la etiología es desconocida, en1983 Moessinger propuso que una disminución de los movimientos fetales en el útero puede llevar a un cuadro similar y propuso llamarlo secuencia de deformación por acinesia fetal

Fetal akinesia/hypokinesia sequence syndrome is a rare genetic disorder described in 1974 by Pena and Shokeir in two sisters who died at birth with camptodactyly, clubfoot, ankylosis of the knees and hips, and pulmonary hypoplasia. This syndrome affects approximately one in 12,000 newborns, and about sixty cases have been reported in the medical literature, most of which are sporadic. Although the etiology is unknown, in 1983 Moessinger proposed that a decrease in fetal movements in utero can lead to a similar picture and proposed to call it fetal akinesia deformation sequence

Núcleos da base e seu papel no controle motor: implicaçöes para a Doença de Parkinson / Basal ganglia and their function on the motor control: Parkinson's disease implications

O presente trabalho é fruto de uma revisäo atual de literatura sobre os aspectos anátomo-fisiológicos dos núcleos da base, sua funçäo no controle dos movimentos e aborda uma discussäo sobre a doença de Parkinson, uma das patologias que acometem a funçäo destas estruturas. Os achados clínicos frequentes nesta patologia e a implicaçäo que cada um tem sobre os movimentos säo intensamente detalhados. A literatura apresenta papéis vairiáveis e múltiplos para os núcleos da base, porém, descreve algumas funçöes altamente especializadas, com contribuiçöes funcionais específicas, o que auxilia no entendimento da patologia e torna possível uma análise crítica sobre o papel do fisioterapeuta no tratamento de pacientes parkinsonianos. Este seria o grande objetivo do presente trabalho.