Marcos Leal Brioschi

Thermographic and clinical correlation of myofascial trigger points in the masticatory muscles

OBJECTIVES The aim of the study was to identify and correlate myofascial trigger points (MTPs) in the masticatory muscles, using thermography and algometry. METHODS 26 female volunteers were recruited. The surface facial area over the masseter and anterior temporalis muscles was divided into 15 subareas on each side (n=780). This investigation consisted of three steps. The first step involved thermographic facial examination, using lateral views. The second step involved the pressure pain threshold (PPT), marking the MTP pattern areas for referred pain (n=131) and local pain (n=282) with a coloured pencil, and a photograph of the lateral face with the head in the same position as the infrared imaging. The last step was the fusion of these two images, using dedicated software (Reporter® 8.5-SP3 Professional Edition and QuickReport® 1.2, FLIR Systems, Wilsonville, OR); and the calculation of the temperature of each point. RESULTS PPT levels measured at the points of referred pain in MTPs (1.28±0.45 kgf) were significantly lower than the points of local pain in MTPs (1.73±0.59 kgf; p<0.05). Infrared imaging indicated differences between referred and local pain in MTPs of 0.5 °C (p<0.05). Analysis of the correlation between the PPT and infrared imaging was done using the Spearman non-parametric method, in which the correlations were positive and moderate (0.4≤r<0.7). The sensitivity and specificity in MTPs were 62.5% and 71.3%, respectively, for referred pain, and 43.6% and 60.6%, respectively, for local pain. CONCLUSION Infrared imaging measurements can provide a useful, non-invasive and non-ionizing examination for diagnosis of MTPs in masticatory muscles.

Repeatability of Infrared Plantar Thermography in Diabetes Patients: A Pilot Study

Objective: Infrared (IR) thermography has been used as a complementary diagnostic method in several pathologies, including distal diabetic neuropathy, by tests that induce thermoregulatory responses, but nothing is known about the repeatability of these tests. This study aimed to assess the repeatability of the rewarming index in subjects with type 2 diabetes mellitus (T2DM) and nondiabetic control subjects. Methods: Using an IR camera, plantar IR images were collected at baseline (pre-) and 10 min after (post-) cold stress testing on two different days with 7 days interval. Plantar absolute average temperatures pre- and post-cold stress testing, the difference between them (AT), and the rewarming index were obtained and compared between days. Repeatability of the rewarming index after the cold stress test was assessed by Bland-Altman plot limits of agreement. Results: Ten T2DM subjects and ten nondiabetic subjects had both feet analyzed. Mean age did not differ between groups (p = .080). Absolute average temperatures of plantar region pre- (p = .033) and post-cold stress test (p = .019) differed between days in nondiabetic subjects, whereas they did not differ in T2DM subjects (pretest, p = .329; post-test, p = .540). AT and rewarming index did not differ between days for both groups, and the rewarming index presented a 100% agreement of day-to-day measurements from T2DM subjects and 95% with nondiabetic subjects. Conclusions: The rewarming index after cold stress testing presented good repeatability between two days a week in both groups. Despite T2DM subjects presenting no differences on absolute temperature values between days, ΔT or rewarming index after cold stress testing remain recommended beside absolute temperature values for clinical use.

Utilização da imagem infravermelha em reumatologia

Infrared thermography is unique objective imaging procedure for the quantitative assessment of local inflammatory reactions in parts of the locomotor system. For differential diagnosis the thermographic results should be evaluated in conjuction with clinical examination and other technical procedures. As a means of monitoring the course of the local inflammatory activity, however, quantitative infrared thermography is a useful tool in itself, particularly during the application of local and systemic anti-inflammatory therapy.

Thermographic characterization of masticatory muscle regions in volunteers with and without myogenous temporomandibular disorder: preliminary results

OBJECTIVES This study aims to conduct a non-invasive measurement of the cutaneous temperature of selected masticatory muscle regions of volunteers with and without myogenous temporomandibular disorder (TMD), using infrared thermography. METHODS 23 females (10 myogenous TMD volunteers and 13 controls) were recruited and studied. The temperature at the surface of the facial area over the anterior temporalis and masseter muscles was assessed by medical thermography, using regional lateral views and clinical examination. RESULTS The temperature levels measured at the masseter and anterior temporalis muscle regions in myogenous TMD volunteers (32.85 ± 0.85 and 34.37 ± 0.64 ºC, respectively) were significantly lower (p < 0.05) than those measured in controls (33.49 ± 0.92 and 34.78 ± 0.44 ºC, respectively). Medical infrared imaging indicated a mean difference of 1.4 ºC between the masseter and anterior temporalis regions. Analysis of the comparison between the absolute and normalized mean temperatures was performed using the pairwise comparison of receiver operating characteristic curves, and no statistically significant difference was observed (p > 0.05). The sensitivity and specificity of the thermographic assessment for the masseter region was of 70% and 73%, respectively and for the anterior temporalis region was of 80% and 62%, respectively. CONCLUSIONS This method of evaluating masticatory muscle regions of this preliminary study seems to indicate that it can be used as an aid in complimentary diagnosing of TMDs.

O uso da termografia infravermelha na avaliação do retorno ao trabalho em programa de reabilitação ampliado (PRA)

Em certas ocasioes, mesmo com tratamento corretamente instituido em pacientes com lesoes por esforcos repetitivos/disturbios osteomusculares relacionados ao trabalho (LER/DORT), depara-se com situacoes de dificil julgamento quanto ao retorno ao trabalho. Muitas vezes por uma queixa persistente de nao melhora dos sintomas ou quando associado a outras comorbidades, como sindrome fibromialgica. O objetivo deste estudo foi comparar os padroes termicos encontrados com a avaliacao pericial de retorno ao trabalho de pacientes acometidos por LER/DORT, por meio de avaliacao clinica e termografica duplo-cega. Foram avaliados 128 pacientes, acometidos por LER/DORT de uma empresa do setor da agroindustria- frigorifico, onde um grupo de 62 pacientes foi selecionado para pericia quanto ao retorno ao trabalho. Destes, 3,2% tiveram retorno imediato ao trabalho, 77,4% afastamento por 60 dias, 6,4%, afastamento por 6 meses e 12,9% aposentadoria por invalidez. As alteracoes termicas tiveram direta correlacao com a classificacao de retorno as atividades realizadas pelos peritos, segundo criterios de numero de lesoes, natureza etiologica, diferencial termico e indice termografico para sindrome fibromialgica. A termometria cutânea por termografia infravermelha demonstrou-se como metodo complementar util e objetivo no apoio a avaliacao pericial para definicao de capacidade ou incapacidade para o trabalho.

Análise da redistribuição de calor com agentes inalatórios, em ratos submetidos a laparotomia e pneumoperitônio, através da termografia infravermelha

BACKGROUND AND OBJECTIVES Anesthesiology involves the handling of situations inherent to anesthetic and surgical procedures which lead to patients thermal homeostasis unbalance, with noxious physiological effects. This study aimed at qualifying and quantifying thermal redistribution in rats subjected to inhalation anesthesia, during induction and in surgical situations of laparotomy and increased intra-abdominal pressure. METHODS The study involved 90 rats, submitted to inhalation anesthesia, which were distributed in three groups: halothane; isoflurane; sevoflurane. Each group was divided in subgroups: I - control; II - median laparotomy with bowel exposure; III - 15 mmHg Increase in intra-abdominal pressure. Heat loss was measured by an esophageal probe and infrared thermal image. RESULTS There were no significant differences among inhalation anesthetics regarding heat loss between groups I and II. In group III, there was a difference between isoflurane and sevoflurane and isoflurane was responsible for the highest heat loss.

[Analysis of heat loss using inhalation agents in rats subjected to laparotomy and increased intra-abdominal pressure, using digital infrared thermal image].

BACKGROUND AND OBJECTIVES Anesthesiology involves the handling of situations inherent to anesthetic and surgical procedures which lead to patients thermal homeostasis unbalance, with noxious physiological effects. This study aimed at qualifying and quantifying thermal redistribution in rats subjected to inhalation anesthesia, during induction and in surgical situations of laparotomy and increased intra-abdominal pressure. METHODS The study involved 90 rats, submitted to inhalation anesthesia, which were distributed in three groups: halothane; isoflurane; sevoflurane. Each group was divided in subgroups: I - control; II - median laparotomy with bowel exposure; III - 15 mmHg Increase in intra-abdominal pressure. Heat loss was measured by an esophageal probe and infrared thermal image. RESULTS There were no significant differences among inhalation anesthetics regarding heat loss between groups I and II. In group III, there was a difference between isoflurane and sevoflurane and isoflurane was responsible for the highest heat loss.

Using thermography for an obstruction of the lower lacrimal system

Obstructions in the lacrimal pathways quite often require accurate and reliable image scanning for confirmation and documentation. Infrared thermal imaging, known as thermography, is a resource that complements diagnosis; it does not require touching the patient or applying contrast materials and has been used in various medical procedures for decades. However, there have been few studies in the literature about its use in ophthalmology. In this paper, the authors have presented a case of dacryocystitis where the obstruction of the lacrimal punctum was so acute that conventional dacryocystography could not be used. The authors have successfully reported the use of thermography as a complementary propaedeutic and will discuss the method they used.

The facial thermal effect of dynamic mechanical and vascular provocation tests: Preliminary study

Anatomical and functional information of the structures of interest is the basis of radiology interpretation. Many diagnosis of some facial diseases may be done through medical imaging techniques, however the most conventional present lack of information in analyzing physiological functional aspects such as microcirculation and autonomous nervous system. This study aims to evaluate and compare 2 techniques of dynamic infrared thermography (chewing and vibration tests associated with thermal test) in 3 skin facial regions of volunteers with and without temporomandibular disorder (DMT). Sixty-four participants (24 symptomatic and 40 asymptomatic) were included. The surface temperature over trochlear, supraorbital and facial arteries and veins was assessed by medical thermography, using regional frontal views and clinical examination. Results show that the cutaneous temperature over the ROIs does not change in the presence of DMT. The functional tests did not have statistical evidence of independence (p>0.05). This preliminary assessment was made only in front views. A future evaluation of lateral thermal imaging is advised because it can provide important and new pathophysiological information in the characterization for DMT subjects and healthy individuals.

Infrared thermography to diagnose and manage venomous animal bites and stings

INTRODUCTION Infrared imaging (IR) is a noninvasive technique that quantifies body surface temperature, producing a digital color image. IR has been used to study diseases in which skin temperature can reflect the presence of inflammation. METHODS This was an observational pilot study of eight patients envenomed by snakes, spiders, and scorpions. All patients were examined using a thermal camera. RESULTS In all cases, we obtained infrared images that corroborated clinical findings indicating localized effects of venom, specifically inflammation. CONCLUSIONS IR has potential for use as a research, diagnostic, and monitoring tool for localized effects of animal venoms.