Analysis of the effects of low-level laser therapy on muscle fatigue of the biceps brachii muscle of healthy individuals and spastic individuals: Study protocol for a single-center, randomized, double-blind, and controlled clinical trial.

BACKGROUND: Muscular fatigue is caused by biochemical alterations that modify the mechanics of muscle contraction, resulting in negative changes in the performance of the contraction. Several resources are studied to mitigate this situation among which we can cite low-level laser therapy (LLLT). The effects of LLLT are being studied in healthy subjects with fibromyalgia and who are athletes, and currently the studies are being performed in spastic muscles with poststroke individuals. The aim will be to evaluate the effects of LLLT on the fatigue of the biceps brachii muscle of healthy individuals and individuals with spastic hemiparesis. METHODS: A cross-sectional, comparative, randomized, placebo, double-blind clinical trial will be divided into 2 phases: phase I shall consist of 30 healthy subjects and phase II of 30 poststroke individuals. The study will consist of 3 groups (control group, placebo group, and LLLT group), and all individuals will pass through all groups, following the randomization criteria. The protocol consists of the application of LLLT in the biceps brachii muscle on the dominant side in healthy individuals and in the hemiparetic side of poststroke individuals, and, subsequently, 3 maximal isometric voluntary contractions (MIVCs) will be performed for 50 seconds in the dynamometer, with an interval of 50 seconds between them. Pain intensity will be evaluated by means of the visual analog scale, and the myoelectric activity by means of surface electromyography associated with the evaluation of muscular strength by means of the dynamometer. The local temperature will be evaluated by infrared thermography and blood lactate concentration through the lactimeter, which will be measured at 4 different times, before the application of the laser (basal), and 3, 15, and 25 minutes after the MIVC.

Reticuloide actínico / Actinic reticuloid

Los pseudolinfomas son enfermedades inflamatorias que simulan linfomas clínica y/o histopatológicamente. El reticuloide actínico se encuadra dentro de los pseudolinfomas T. Afecta casi exclusivamente a hombres ancianos. Los principales factores etiopatogénicos son el contacto con fotoalergenos y el aumento de la sensibilidad a la radiación UVA, UVB y a veces a la luz visible. Clínicamente comienza con lesiones eccematosas, muy pruriginosas, en zonas fotoexpuestas, con tendencia a generalizarse. Histológicamente evoluciona de una dermatitis eccematosa a un infiltrado linfocitorio en banda que remeda una micosis fungioide. No obstante, se ha demostrado la no clonalidad de los linfocitos y el predominio de los linfocitos T supresores sobre los T colaboradores, a diferencia de lo que ocurre en la mayoría de los casos de micosis fungoide. El tratamiento es difícil ya que se trata de una enfermedad crónica que suele recidivar al suspenderlo. Se han utilizado corticosteroides, azatioprina, ciclosporina, PUVA y rayos UVB con resultados parciales. Aunque se ha comunicado la aparición de linfomas y otras neoplasias en el transcurso de la evolución de estos pacientes, la posible malignización del proceso sigue sujeta a controversia (AU)

Hyperbaric oxygen in the treatment of delayed radiation injuries of the extremities.

Hyperbaric oxygen (HBO2) is used as an adjunct in the treatment of radiation injury at many sites, including the mandible, larynx, chest wall, bladder, and rectum. In these disorders, HBO2 is effective in stimulating neovascularization and reducing fibrosis. No previous publications report the application of HBO2 to radiation injuries of the extremities. From 1979 until 1997, 17 patients were treated at the Southwest Texas Methodist and Nix Hospitals for nonhealing necrotic wounds of the extremities within previously irradiated fields. All but one wound involved a lower extremity. Most of the patients had been irradiated for soft tissue sarcomas or skin cancers. The rest were irradiated for a variety of malignancies. HBO2 was delivered in a multiplace chamber at 2.4 atm abs daily for 90 min of 100% oxygen at pressure. This report is a retrospective, uncontrolled review of these patients. Eleven patients (65%) healed completely whereas five (29%) failed to heal and one (6%) was lost to follow-up. Three (60%) of those who failed were found to have local or distant recurrence of their tumor early in their course of hyperbaric treatment and were discontinued from therapy at that time. When last seen in the clinic, the wound of the patient who was lost to follow-up was improved but not completely healed. Four of those who failed (including the two with local tumor recurrence) required amputation. If we exclude those with active cancer and the patient lost to follow-up, the success rate was 11 of 13 or 85%. HBO2 was applied successfully with complete wound healing and the avoidance of amputation in a majority of these patients. The consequences of failure in patients suffering from radiation necrosis of the extremities (some complicated by the presence of tumor) are significant, with 80% of the five failures requiring amputation. In radiation injuries of the extremities as in delayed radiation injury at other sites, HBO2 is a useful adjunct and should be part of the overall management.

Solar (brachioradial) pruritus--response to capsaicin cream.

BACKGROUND: Solar (brachioradial) pruritus is an enigmatic condition affecting the lateral aspects of the arm(s) and is primarily seen in Caucasian people living in the tropics or subtropics. METHODS: Over a 5-year period we prospectively evaluated 68 patients with solar pruritus seen in an outpatient dermatology clinic. Clinical, biochemical, and microscopic and ultramicroscopic studies were performed. An open-label trial of capsaicin cream application was initiated in 15 patients. RESULTS: An almost equal number of men and women were seen with an average age of 44 years. Brown-eyed and blue-eyed patients were seen with equal frequency. Most patients (86%) had outdoor occupations or avocations. The pruritus was intense, usually bilateral (72%) and invariably affected the lateral (as opposed to medial) aspects of the arm(s) in the absence of primary lesions. The most commonly affected area was the elbow area superficial to the brachioradialis and extensor carpi longus muscles, but extension of the pruritus to include the forearm and/or upper arm was common. Biopsy specimens (stained with hematoxylin and eosin) were normal or showed mild actinic elastosis in 15 patients tested. Ultramicroscopy showed myelin sheath splitting in all four patients studied. This is a nonspecific finding that may also be found in diabetic or alcoholic neuropathy. Ten of thirteen patients completing the capsaicin-cream study found significant relief (itching much improved or gone) after 3 weeks compared with the untreated control arm. CONCLUSIONS: The cause of solar pruritus remains unknown, but circumstantial evidence implicates chronic exposure to solar radiation. Capsaicin may offer relief to these patients, but the patients need to be cautioned about the burning sensation that occurs with capsaicin cream.