Eduardo José Danza Vicente

Influência da porção extensora do músculo glúteo máximo sobre a inclinação da pelve antes e depois da realização de um protocolo de fadiga

INTRODUCTION: There is a lack of data in the literature for determining the influences of the extensor portion of the gluteus maximus muscle on pelvic tilting and, thus, on lumbar stability. OBJECTIVES: To assess the influences of the extensor portion of the gluteus maximus muscle on pelvic tilt. METHODS: Ten healthy young subjects were recruited, with a body mass index (BMI) below 24.9 kg/m2 and leg length discrepancy below 1 cm. The BMI, pelvic perimeter and lower-limb lengths were assessed and, subsequently, the degrees of hemi-pelvic tilt and asymmetry between them were analyzed using lateral view photographs of the subjects in a standing position, using SAPO (Software for Postural Assessment). Next, fatigue was induced in the extensor portion of the gluteus maximus muscle on the dominant side, and after that the hemi-pelvic tilt and the asymmetry between the hemi-pelvises were reassessed. The Pearson r and Student t tests were conducted at the significance level of α=0.05. RESULTS: There were no significant correlations between the confounding variables and asymmetry of the hemi-pelvic angles. There were significant changes in the hemi-pelvic angle of the dominant side (t=3.760; p=0.004). CONCLUSIONS: Fatigue in the extensor portion of the gluteus maximus muscle can generate increases in the tilt angle of the ipsilateral pelvis.

Manejo clínico de úlceras venosas na atenção primária à saúde

Objective: To discuss the clinical management of venous ulcers in primary health care, based on the vision of users who live with this afflic tion. Methods: This was a qualitative, exploratory, descriptive study, conducted with 25 adult users in treatment in the Family Health Units. Data were collected in the second semester of 2008, using a structured instrument with questions of sociodemographic characteristics, type of cleaning, coverings, use of compression therapy, medication and prescribed guidelines. Results: Cleaning products are used that aggravate the granulation tissue, such as coverings with various substances, including sunflower oil and antibiotic ointments; the majority of users do not use measures to control edema. Conclusion: It is necessary to elaborate and adopt clinical protocols for the care of venous ulcers, as well as to provide ongoing education for health professionals.

Clinical management of venous ulcers in primary health care

Objective: To discuss the clinical management of venous ulcers in primary health care, based on the vision of users who live with this afflic tion. Methods: This was a qualitative, exploratory, descriptive study, conducted with 25 adult users in treatment in the Family Health Units. Data were collected in the second semester of 2008, using a structured instrument with questions of sociodemographic characteristics, type of cleaning, coverings, use of compression therapy, medication and prescribed guidelines. Results: Cleaning products are used that aggravate the granulation tissue, such as coverings with various substances, including sunflower oil and antibiotic ointments; the majority of users do not use measures to control edema. Conclusion: It is necessary to elaborate and adopt clinical protocols for the care of venous ulcers, as well as to provide ongoing education for health professionals.

Estudo das relações anatômicas e suas variações entre o nervo ciático e o músculo piriforme

Study on anatomical relationships and variations between the sciatic nerve and piriform muscle Context: Piriform muscle syndrome can be caused by abnormal passage of the sciatic nerve or one of its parts through the belly of the piriform muscle. Objective: To analyze the anatomical and measurement relationships between the piriform muscle and the sciatic nerve in order to contribute towards better anatomoclinical understanding of the gluteal region. Method: Twenty adult cadavers of both sexes were used. The sciatic nerve and piriform muscle were dissected, measured and photodocumented. Results: The sciatic nerve was seen to be a single trunk passing through the lower margin of the piriform muscle in 85% of the 40 gluteal regions, and 15% showed bilateral variation characterized by the passage of the common fibular nerve through the piriform muscle. The data obtained did not show any statistically significant differences.

Energy expenditure and cardiovascular response to traumatic lower limb amputees’ gait

Introduction Amputations cause functional, musculoskeletal and cardiovascular alterations and, the more proximal the amputation, the larger the alterations. Objectives To observe the effect of using lower limb prosthetics and that of gait speed on heart rate (HR), blood pressure (BP), oxygen consumption (VO2) and energy cost (EC) during gait in traumatic lower limbs amputees. Materials and methods The sample was composed of 30 men with unilateral amputations, 10 transfemoral and 10 transtibial, compared to 10 people with no amputations. All of them selected a pleasant walking speed (PWS) on the treadmill, and two other speeds were calculated, 20% above and 20% below the original one. The subjects walked for 10 minutes at each of the speeds and, in the last three minutes, the VO2, HR, and BP were assessed. In order to compare variables between groups the variance was performed (ANOVA) followed by the Post Hoc Sheffe test (p < 0.05). Results The amputees selected lower values of PWS and had higher HR, BP, and EC, VO2 during gait when compared to normal individuals. The transfemoral amputees had higher VO2 and EC compared to the transtibial ones. By analyzing the speed effect, it was observed that, although the VO2 did not increase with the increased speed, there was increased cardiovascular response and reduced EC. Conclusions Traumatic lower limb amputees have higher energy expenditure and cardiovascular responses during gait and, at higher speeds, they become more economical, reducing the EC.

Descarga de peso e prevalência de degeneração no joelho de indivíduos amputados

INTRODUCTION: In individuals with amputation, the knees suffer an imbalance in weight bearing between lower limbs that can lead to development of osteoarthritis (OA). OBJECTIVE: To quantify the weight bearing in lower limb prosthetic individuals and correlate this bearing with time of prosthesis use, age and prevalence of osteoarthritis diagnosis. MATERIALS AND METHODS: This study included 12 patients with unilateral transfemoral or transtibial amputation, were patients between 19 and 64 years of age. They were evaluated by a computerized baropodometro, IST Informatique® brand, model Foot Work to quantify the weight bearing on the lower limbs, by a radiographic examination of the intact knee in the anteroposterior incidence, to verify a possible joint degeneration. Patients were also examined by a rheumatologist for possible association of degeneration with clinical signs. RESULTS: The average of weight bearing of intact limb was 58.08% (± 5.88) and amputed limb was 41% (± 5.88), with a significant statistical difference. Twenty-five percent of the 12 individuals had radiological diagnosis of mild joint degeneration in the non-amputed knee and none of them had diagnosis of OA. There was no significant association between age, time of prosthesis use and weight bearing. However individuals with older age and shorter time of prosthesis use showed greater imbalance in the weight bearing. CONCLUSION: Lower limbs amputees have an excessive loading on the intact limb, so that the older the individual who is prosthetic and the shorter the period of prosthesis use, higher will be the excessive loading. Individuals who were prosthetic after the thirties have more tendencies to joint degeneration in the intact knee.

Manejo clínico de úlceras venosas en la atención primaria a la salud

Objective: To discuss the clinical management of venous ulcers in primary health care, based on the vision of users who live with this afflic tion. Methods: This was a qualitative, exploratory, descriptive study, conducted with 25 adult users in treatment in the Family Health Units. Data were collected in the second semester of 2008, using a structured instrument with questions of sociodemographic characteristics, type of cleaning, coverings, use of compression therapy, medication and prescribed guidelines. Results: Cleaning products are used that aggravate the granulation tissue, such as coverings with various substances, including sunflower oil and antibiotic ointments; the majority of users do not use measures to control edema. Conclusion: It is necessary to elaborate and adopt clinical protocols for the care of venous ulcers, as well as to provide ongoing education for health professionals.