Concomitant Transverse Myelitis and Acute Axonal Sensory-Motor Neuropathy in an Elderly Patient.

Diagnosing concomitant transverse myelitis (TM) and Guillain-Barré syndrome (GBS) can be challenging. We report a case of an elderly patient presenting with acute sensory and motor disturbances in the four limbs, associated with urinary retention, ophthalmoparesis, facial weakness, and dysarthria. Electrodiagnostic studies were consistent with acute motor sensory axonal neuropathy (AMSAN), and imaging showed a longitudinally extensive tumefactive contrast-enhancing hyperintense spinal cord lesion extending from T6 to the cone. Concomitant AMSAN and TM have not been previously reported in the elderly. Comorbid TM and other GBS variants have been previously reported. Intravenous methylprednisolone, plasma exchange, cyclophosphamide, or combination therapies are usually used, although there are no randomized controlled studies regarding treatment choices.

Sensory abnormalities and pain in Parkinson disease and its modulation by treatment of motor symptoms.

Pain and sensory abnormalities are present in a large proportion of Parkinson disease (PD) patients and have a significant negative impact in quality of life. It remains undetermined whether pain occurs secondary to motor impairment and to which extent it can be relieved by improvement of motor symptoms. The aim of this review was to examine the current knowledge on the mechanisms behind sensory changes and pain in PD and to assess the modulatory effects of motor treatment on these sensory abnormalities. A comprehensive literature search was performed. We selected studies investigating sensory changes and pain in PD and the effects of levodopa administration and deep brain stimulation (DBS) on these symptoms. PD patients have altered sensory and pain thresholds in the off-medication state. Both levodopa and DBS improve motor symptoms (i.e.: bradykinesia, tremor) and change sensory abnormalities towards normal levels. However, there is no direct correlation between sensory/pain changes and motor improvement, suggesting that motor and non-motor symptoms do not necessarily share the same mechanisms. Whether dopamine and DBS have a real antinociceptive effect or simply a modulatory effect in pain perception remain uncertain. These data may provide useful insights into a mechanism-based approach to pain in PD, pointing out the role of the dopaminergic system in pain perception and the importance of the characterization of different pain syndromes related to PD before specific treatment can be instituted.

Current status of cardiac CT for the detection of myocardial ischemia.

Stress and rest myocardial perfusion imaging using computed tomography (CT) can be accurately and safely performed. CT angiography allows for the anatomic visualization of coronary lesions and the components of atherosclerotic plaque, whereas according to currently available data, CT perfusion imaging improves the diagnostic accuracy for detecting ischemic lesions. However, the radiation exposure and contrast load that are involved cannot be neglected. Owing to the limited number of trials that have been published so far, and the fact that they used a wide variety of image acquisition and stress protocols, a standard acquisition protocol for CT perfusion imaging still needs to be found and evaluated in larger multicenter trials. Therefore, CT perfusion imaging, as opposed to other modalities such as magnetic resonance perfusion, SPECT, or positron emission tomography, cannot yet be regarded as clinical routine, but may be considered in patients with contraindications for other imaging modalities.

DHM simulation in virtual environments: a case-study on control room design.

This paper will present the workflow developed for the application of serious games in the design of complex cooperative work settings. The project was based on ergonomic studies and development of a control room among participative design process. Our main concerns were the 3D human virtual representation acquired from 3D scanning, human interaction, workspace layout and equipment designed considering ergonomics standards. Using Unity3D platform to design the virtual environment, the virtual human model can be controlled by users on dynamic scenario in order to evaluate the new work settings and simulate work activities. The results obtained showed that this virtual technology can drastically change the design process by improving the level of interaction between final users and, managers and human factors team.

Evaluación del efecto de diferentes cepas de levadura (Montrachet, K1-V1116, EC-1118, 71B-1122 y IVC-GRE ®) y clarificantes sobre los atributos sensoriales del vino de naranja criolla (Citrus sinensis) / Evaluation of effect of various strains of yeast (Montrachet, K1-V1116, EC-1118, 71B-1122 y IVC-GRE ®) and clearer on the sensory attributes orange wine (Citrus sinensis)

En este trabajo se evaluó el efecto de diferentes cepas de levadura (Montrachet, K1-V1116, EC-1118, 71B-1122 y IVC-GRE ®) sobre los atributos sensoriales del vino de naranja. Estos atributos fueron medidos utilizando la escala modificada de UC Davis. En una prueba de ordenamiento para determinar el mejor tratamiento de clarificación se determinó que la gelatina por sí sola no causa efecto sobre el atributo apariencia general, la combinación de la gelatina y la microfiltración tienen un efecto positivo sobre la apariencia del vino de naranja. Los cinco vinos tratados con diferentes levaduras presentaron diferencias significativas sobre la puntuación total, acidez total, sabor y calidad en general. En términos del efecto de las levaduras, la evaluación sensorial realizada a los vinos mostró que el de naranja con la levadura K1-V1116 fue el que sobresalió en términos de puntuación en los promedios de casi todos los atributos analizados por el panel sensorial.

In this Wort was evaluated the effect of different types of strains of yeast (Montrachet, K1-V1116, EC-1118, 71B-1122 y IVC-GRE) over the sensorial attributes of orange wines were also studied. These attributes were measured in a modified scale of UC Davis. By using an order test in order to know the best cleared treatment, it was determined that gelatin by itself does not cause any effect over the general quality attribute, but the combination of gelatin and microfiltration, cause a positive effect over the orange wine appearance. The five wines treated with different yeasts presented significant differences on individual scores, total acidy, flavor and general quality of the UC Davis scale. The sensorial evaluation of wines showed that the yeast K1-V1116 produced the best rated orange wine. This wine was significantly different over many attributes when compared with the other wines evaluated by the sensorial panel.

Criação de protocolo de avaliação do equilíbrio corporal em crianças de quatro, seis e oito anos de idade: uma perspectiva funcional / Creation of a balance assessment protocol of balance for four, six and eight-year-old children: a functional perspective

OBJETIVO: O objetivo desse estudo foi criar um teste de equilíbrio corporal, em contexto funcional, e verificar sua adequação e aplicabilidade em um grupo de crianças brasileiras. MÉTODO: Os participantes foram 66 crianças, com desenvolvimento motor típico, idades cronológicas de quatro, seis e oito anos, selecionadas em três escolas de classe média. Cada grupo etário foi composto por 22 crianças, sendo 11 meninos e 11 meninas. O protocolo elaborado foi constituído por oito provas, distribuídas em dois circuitos. Todas as provas foram avaliadas por critérios quantitativos e qualitativos. Os critérios quantitativos referiram-se ao tempo gasto e ao número de passos e saltos corretamente executados nas provas correspondentes. A avaliação qualitativa, pontuada em escala ordinal de quatro pontos, foi baseada em verbos de ação. RESULTADOS: Os resultados da correlação intraclasse indicaram nível satisfatório de confiabilidade entre examinadores e a confiabilidade teste-reteste. Para a comparação do desempenho entre os três grupos etários foi utilizado o teste Kruskal-Wallis e, para localizar a diferença entre os grupos, o teste U Mann-Whitney. Crianças de quatro e oito anos apresentam diferença significativa de desempenho nas provas, tanto para critérios qualitativos quanto quantitativos. Observou-se, também, diferença no desempenho entre crianças de quatro e seis anos para algumas das provas avaliadas. Crianças de seis e de oito anos, de um modo geral, não apresentam diferenças nas provas de equilíbrio propostas. CONCLUSÃO: O instrumento tem potencial para uso clínico. Estudos futuros deverão verificar a utilidade clínica do protocolo em crianças que apresentam atraso no desenvolvimento motor.

OBJECTIVE: To create a body balance test within a functional context and verify its adequacy and applicability among a group of Brazilian children. METHOD: The participants were 66 children with typical motor development and chronological ages of four, six and eight years old, who were selected at three schools with middle-class intake. Each age group was composed of 22 children (11 girls and 11 boys). The test protocol was composed of eight tasks distributed in two circuits. All the tasks were scored by quantitative and qualitative criteria. The quantitative criteria were based on the time taken and the number of steps/jumps correctly performed in the corresponding items. The qualitative assessment was scored on a four-point ordinal scale, based on action verbs. RESULTS: The intraclass correlations between examiners and the test-retest reliability were satisfactory. To compare the performance between the three age groups, the Kruskal-Wallis test was utilized, and to locate the differences between groups, the Mann-Whitney U test was used. There were significant differences in performance between the four and eight-year-old children in the tasks, both for qualitative and quantitative criteria. Differences in performance between the four and six-year-old children were also observed for some of the tasks assessed. Most of the differences between the six and eight-year-old children in the balance tasks examined were not significant. CONCLUSION: The assessment tool has potential for clinical use. Future studies should verify the clinical utility of the protocol among children presenting delayed motor development.

Early mortality in liver transplantation: bilirubin as predictor of outcome.

The shortage of donor organs and the long waiting lists have increased the need to better select liver transplant candidates using predictors of success. We reviewed the results of 29 liver transplantations performed from January 2002 to February 2003 analyzing the correlations with early mortality (30 days) of patient data, pretransplant laboratory data, warm ischemia time, intraoperations blood unit transfusions, and postoperative complications of prolonged mechanical ventilation, dialysis, and infection. Overall early mortality was 27.6% and 44% in fulminant hepatic failure (n = 9), there were four retransplants with one death, and two intraoperative deaths. Only pretransplant bilirubin (P =.045) and postoperative lactate levels (P =.002) were significantly different between alive versus dead patients. In this small population bilirubin was more related to death than the MELD score. Lactate levels, nonspecific predictor of death in shock syndromes were probably related to septic complications.

The use of CTA in the chest pain center: a perspective.

Suitable imaging methods to reliably rule out coronary artery disease as the underlying condition might be beneficially applied in the workup of patients with acute chest pain. The temporal and spatial resolution of computed tomgraphy and electron beam computed tomography has seen continuous improvements over the past years. Current scanner generations permit relatively reliable visualization of the coronary arteries and several studies have demonstrated a high negative predictive value to rule out coronary artery stenoses. Even though applications in the context of acute coronary syndromes have not yet been specifically evaluated, it seems likely that computed tomography imaging may develop into a tool that can be integrated into the workflow in chest pain centers once appropriate studies have been performed.

Morpho-histological analysis of abdominal skin as related to liposuction.

The analysis of the abdominal skin on cadavers has made it possible for the authors to evaluate the skin's regional characteristics, taking into consideration the age group to be lipoaspirated regardless of race or sex. In this way, norms are established which in the future may be used to comparatively analyze results related to the cutaneous retraction after plastic surgery lipoaspiration.

[Munchausen's syndrome by proxy: a case report of a girl with a recurrent factitious bleeding ear]. / Síndrome de Munchausen por procuração: o caso da menina que sangrava pelo ouvido.

This is a case report of a three-year-old girl with recurrent ear bleeding which was actually recurrent factitious symptomatology, perpetrated by the mother, which caused the child to undergo many harmful diagnostic procedures. This is a documented case, probably the first case reported in Latin America, and it is also the only one in which there is mention of the mother demonstrating interest in divulging the case. Munchausen's Syndrome by Proxy (MSBP) is a specific modality of child abuse. The mother, often the perpretator, affect concern and affection. The consequences are both psychological and physical and can determine child's death. Diagnosis is rarely considered.

Conduta na pancreatite aguda / Procedures in the acute pancreatitis

Os autores analisam de forma esquematica os procedimentos clinicos e cirurgicos no tratamento da pancreatite aguda e de suas complicacoes

Drogas administradas a gestante e suas repercussoes hematologicas no recem-nascido. / Drug administration to pregnant women and its haematologic repercussions in the newborn infant

Os autores analisam as repercussoes, do ponto de vista hematologico para o recem-nascido, de drogas usadas pela gestante, destacando hemorragia, doenca hemolitica neonatal, plaquetopenia e metemoglobinemia. Comentam que o valor terapeutico das drogas deve ser avaliado com base nos possiveis efeitos adversos para o feto e para o recem-nato