A paralisia facial é uma patologia de etiologia ampla, com prejuízos múltiplos e severos aos indivíduos afetados. Dentre os tratamentos cirúrgicos atualmente propostos a reanimação facial com retalho de músculo temporal se posiciona intermediariamente no espectro de complexidade. Neste estudo objetivou-se a identificação dos resultados com seu uso em nossa disciplina, pela revisão dos prontuários dos pacientes acometidos de tal patologia nos últimos 17 anos. Dos 152 prontuários avaliados, 93 se enquadravam nos critérios de inclusão. Destes, 36 casos com paralisia facial periférica completa foram passíveis de estudo, correspondendo a 39% dos casos de transposição. Os resultados foram uma predominância de pacientes do sexo feminino (26) em relação ao sexo masculino (10). A reanimação conjunta de pálpebra e boca com a transposição do músculo temporal correspondeu a 16 casos; pálpebra a 12 casos; e boca a 8 casos. Nos casos com transplante muscular microcirúrgico, o músculo grácil foi utilizado. A média de procedimentos ancilares das pacientes do sexo feminino foi superior a do sexo masculino. Alterações da técnica da transposição do músculo temporal foram observadas em casos a partir de 2001, com a neurotização muscular por enxerto transfacial de nervo sural em 9 casos. A técnica utilizada em nosso serviço se baseia no retalho de Gillies, mas com utilização da própria fáscia do temporal para seu alongamento, tanto para o tratamento das pálpebras como da boca. A neurotização do músculo temporal como descrita é inédita na literatura, e passível de futura comparação de resultados com as técnicas mais atuais. / Facial palsy is pathology with a great number of causes, with important deficits to the patients. Among the surgical treatments used, the facial reanimation with temporalis muscle flap is a medium complexity procedure. This study intended to identify the results gained with this procedure in our division, analyzing the data of the patients who underwent the temporalis muscle transposition in the last 17 years. One hundred fifty two cases were reviewed, with 93 fulfilling the inclusion criteria. From these, 36 cases of complete facial paralysis reviewed, corresponding to 39% of the whole. Results showed a higher incidence of women in the study, with 26 against 10 men. Motion reanimation of the eyelids and mouth together with the temporalis transposition corresponded to 16 cases, 12 cases were to reanimation of the eyelids only, and eight cases to the mouth. When free muscle transplant was used for facial reanimation, all the cases were done with the gracilis muscle flap. Women had a higher rate of surgeries compared to men. Modifications of the procedure were observed in recent cases, after 2001. Neurotization of the transposed temporalis muscle flap was achieved with a cross-face sural nerve graft in 9 cases. The temporalis transposition technique used I our division is based on the Gillies? one, but using the temporalis fascia to make the flap longer. The temporalis muscle neurotization used wasn?t find in the literature, promising good results in future controlled prospective comparisons.

Mediante levantamento da fortuna crítica e da leitura atenta da obra de Joyce, este trabalho investiga os empregos da música em Dubliners, tanto no âmbito da forma quanto no conteúdo. Quanto aos usos formais, destacam-se estratégias comuns à poesia, como assonâncias, aliterações, ritmos, métricas, onomatopeias, além de elementos estruturais mais complexos, próprios da linguagem musical, como leitmotiv, contraponto, tema e variação. A dissolução da causalidade e a maneira diversa de lidar com a tensão para a construção do enredo se assemelham a alguns recursos musicais aplicados pelos modernistas que produziram o gradativo desmantelamento do sistema tonal. Quanto aos usos musicais que atuam diretamente no conteúdo, destacam-se as alusões a obras musicais e tem papel decisivo para a construção da atmosfera, caracterização de personagens, e desenvolvimento do enredo. A hipótese do trabalho é que a utilização de elementos musicais na literatura está atrelada diretamente às recorrências temáticas da morte, da paralisia, do contexto histórico irlandês, do amor, da sexualidade e da cultura celta. A aproximação entre música e literatura é em Dubliners seminal e Joyce a desenvolverá amplamente de forma experimental nas obras posteriores, principalmente em Ulysses e em Finnegans Wake, nas quais as transformações de elementos musicais intersectam com a palavra. / Through a survey of the critical fortune and the close reading of James Joyces work, this research investigates the employment of music in Dubliners, both in form and in content. Concerning the formal uses, some strategies common to poetry stand out, such as assonances, alliteration, rhythm, metric, onomatopoeia, apart from more complex structural elements, inherent of musical language, such as leitmotiv, counterpoint, as well as theme and variation. The dissolution of causality and the distinct manner to deal with tension, aiming the building of the plot, resembles some musical resources used by the modernists that produced the gradual dismantling of the tonal system. Concerning the musical uses that act directly on the content, the allusions to musical pieces stand out and play a decisive role in building the atmosphere, constructing characters, and developing the plot. The hypothesis of this study is that the use of musical elements in Joyces text is directly connected with the thematic recurrences of death, paralysis, Irish historical context, love, sexuality, and Celtic culture. The rapprochement between music and literature is seminal in Dubliners and Joyce is going to largely develop it in later works, in which the transformation of musical elements intersect with the words.

A paralisia cerebral é um distúrbio do movimento e da postura, decorrente de disfunção permanente e não progressiva do cérebro em desenvolvimento. As crianças com este tipo de patologia apresentam alterações do tônus dos músculos dos membros, do tronco e do pescoço prejudicando entre outros a grafia. Para auxiliar a reabilitação, visando principalmente a formação das letras, foi desenvolvido um aparelho que exercita os movimentos finos envolvidos na grafia. O dispositivo proporciona o deslocamento de uma caneta seguindo padrões e graus de dificuldades definidos. Na caneta foi montado um freio, dificultando ou facilitando seu deslocamento em função da força exercida para movimenta-la. O freio foi implementado com dois estágios intermediários até chegar ao livre movimento. Quando a força está excessiva para a atividade, um aviso sonoro é acionado. Dois sensores FSR e um dispositivo eletrônico baseado em um microcontrolador HC908Q Motorola proporcionam o controle do freio e o disparo do sinal sonoro. O dispositivo foi testado por voluntários e sua atuação na realização dos exercícios correspondeu ao esperado, sendo que o freio foi liberado nos pontos de maior dificuldade dos traçados, dando maior mobilidade e facilitando o movimento da caneta. O dispositivo vem de acordo às solicitações dos pesquisadores da clínica de fisioterapia da Universidade de Mogi das Cruzes atendendo as dificuldades encontradas por esses na reabilitação de crianças com comprometimento motor dos membros superiores, principalmente no que se refere a grafia. / Cerebral paralysis is a posture and movement disorder, due to a permanent and non-progressive disfunction of a brain in development. Children with this kind of pathology show disturbance of the limbs, trunck and neck muscle\'s tonus damaging, between others, the spelling. To help out in the rehabilitation, intending mainly in the formation of the letters, an equipment that exercises the thin movements engaged in the spelling was created. The gadget provides the displacement of a pen following defined standards and degrees. A brake was put in the pen, making difficult or easy its dislocation depending on the strength done in order to move it. The brake was inserted with two intermediate stages before the free movements. When a excessive strength is done, a sounding warning is activated. Two sensorial equipments FSR and an eletronic gadget based in a micro controller HC908Q Motorola provide the control of the brake and the sounding warning activate. The gadget were tested by voluntary people and its operation corresponded to our hopes, it means that the brake was set free in the places of most difficult of the drawing, giving mobility and making easier the movement of the pen. The gadget comes according to the requests of the University of Mogi das Cruzes physiotherapy clinic researches, attending to the difficulties found by these professionals in the rehabilitation of children with motor disfunction of the upper limbs, mainly in what refers to the spelling.

Introdução: a paralisia facial periférica (PFP) é caracterizada por lesão geralmente unilateral do nervo facial em qualquer parte de seu trajeto. Na paralisia total há perda dos movimentos de todos os segmentos da hemiface ipsilateral à lesão. Clinicamente observa-se que a maioria dos pacientes com PFP em fase flácida apresenta dificuldade para mastigar do lado paralisado, pois a manutenção dos alimentos entre as arcadas dentárias está comprometida pela falta de participação do músculo bucinador. Aliada a isso pode ocorrer incompetência labial devido à flacidez da hemiface afetada em conseqüência à queda da comissura labial ipsilateral. Objetivo: verificar as conseqüências da PFP unilateral na fase flácida, com duração de pelo menos seis meses, na função mastigatória quanto a preferência clínica mastigatória e diferença eletromiográfica entre os masseteres.Casuística e Método: foram selecionados 27 indivíduos de ambos os gêneros, com PFP em fase flácida com pelo menos seis meses de paralisia, com idade entre 16 anos e 67 anos, com dentição natural permanente, selecionados por um protocolo específico, complementado com exame clínico miofuncional e avaliação eletromiográfica de superfície nos músculos masseteres nas provas de aperto dentário e mastigação habitual. Resultados: de acordo com as respostas da anamnese, 77,8% dos pacientes referiram mastigar preferencialmente do lado sadio. Clinicamente, 70% apresentaram preferência mastigatória. A atividade muscular dos bucinadores e orbicular da boca foi estatisticamente significante (p = 0,025) entre os lados sadio e paralisado. Apenas, 22,2% dos pacientes apresentou diminuição de massa do masseter do lado paralisado. Não houve diferença eletromiográfica estatisticamente significante entre os lados sadio e paralisado nos masseteres. Conclusão: no presente estudo, pacientes com PFP unilateral na fase flácida, com duração de pelo menos seis meses, apresentaram preferência clínica mastigatória pelo lado sadio. Não houve diferença clínica e eletromiográfica entre os lados paralisado e sadio nos músculos masseteres / Introduction: peripheral facial paralysis (PFP) usually affects the facial nerve in part or in whole on one side of the face. Most patients with PFP find it difficult to chew on the paralyzed side, especially due to compromised buccinator function. In addition, the sagging of the ipsilateral lip commissure tends to compromise lip competence. In spite of the importance of these associations, the literature on mastication difficulties in PFP patients is scarce, perhaps because the facial nerve has conventionally been considered to be responsible primarily for facial expression. Objective: to evaluate the impact of long-standing peripheral facial nerve paralysis upon mastication, regarding to clinical mastication preference besides clinical and electromyographic activity of the masseters. Method: the study included 27 male and female subjects aged 1669 years with permanent natural dentition and long-standing PFP. Patients answered questions on their mastication habits before and after onset of PFP and were submitted to clinical myofunctional examination and electromyographical tests of the masseters during clenching and habitual mastication. Results: according to the anamnesis, 77.8% claimed to prefer chewing on the unaffected side. Clinically, 70% presented a lateral preference in mastication. In the clinical evaluation, the buccinators and orbicularis oris activity differed significantly (p = 0.025) between the healthy and the paralyzed side. Only 22.2% of the patients presented increased thickness of the contralateral masseters. No statistical significant electromyographic difference was observed between the affected and unaffected masseters. Conclusion: in general, subjects with flaccid-stage PFP for 6 months or longer preferred to masticate on the unaffected side. No significant clinical or electromyographic differences were found between the affected and unaffected side masseter in this patient population

Made available in DSpace on 2016-04-27T18:11:51Z (GMT). No. of bitstreams: 1 Mabile Francine Ferreira Silva.pdf: 9401784 bytes, checksum: 573d5ffa9ece93cede3e5dc40740209b (MD5) Previous issue date: 2011-02-15 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Introduction: The peripheral facial paralysis (PFP) is due to reduction or interruption of axonal transport of the seventh cranial nerve resulting in complete or partial paralysis of the facial movements. The facial deformity and limitation of movement, rather than harming the aesthetics and functionality, may significantly interfere in interpersonal communication (VALENÇA et al., 1999; ADAMS, 1998). This deprivation in facially express emotions can cause a variety of psychological and social problems such as depression, anxiety and isolation. (FOUQUET, 2000; DIELS and COMBS, 1997). Purpose: To investigate the psychic contents and social effects associated with the PFP in adult subjects, performing a comparative analysis on three groups of subjects with PFP: flaccid phases, of recovery and latent. The results were used to prepare a roadmap for speech therapy evaluation of these aspects. Method: Clinical researche quantitative and qualitative. Casuistic: Sitiuation 1 16 adult subjects, of both sexes, aged from 43 to 88 years, with the PFP. Situation 2 - Clinical case study of a female patient 52 years, with the PFP facility for 18 years, diagnosed with unknown and currently has sequels. Procedure: Situation 1 - Open interviews with the subjects from the trigger question was: What were the consequences of the peripheral facial paralysis in your social and emotional life? The material was recorded on audio and video, literally transcribed, organized according to categorical analysis proposed by Bardin (2002) and submitted the frequency descriptive statistics and percentages of occurrence of each psychic content and social effects. Some subjects answered to more than one category. Situation 2 Speech therapy from March 2010 to July 2010 with the description of the procedures such as Facial Condition Assessment, treatment and content myofunctional psychological and social effects involved in this condition. Results and Discussion: The results indicated that compared the subjects with sequels have higher statistical significance of psychic contents and social effects associated with the PFP. Followed, respectively, which are flaccid phases and the recovery. The results suggest that the speech therapist, in addition to performing functional and esthetic of the subject affected by the PFP, listener need for psychological and social aspects involved in this clinical picture in order to assess and seek to reduce the degree of psychological distress and promote social adaptation for these patients. The development of a roadmap with psychological and social s indicators aspects facilitate the access of professionals to these contents. Conclusion: The biopsychosocial approach of patients affected by the PFP revealed broad and significant range of subjective contents that justify further studies that may contribute to the effectiveness of the clinical method in speech therapy of this clinical approach / Introdução: A paralisia facial periférica (PFP) decorre da redução ou interrupção do transporte axonal ao sétimo nervo craniano resultando em paralisia completa ou parcial da mímica facial. A deformidade facial e a limitação de movimentos, mais do que prejudicar a estética e a funcionalidade, podem interferir significativamente na comunicação interpessoal (VALENÇA e cols., 1999; ADAMS, 1998). Essa privação em expressar facialmente as emoções pode acarretar uma variedade de problemas psíquicos e sociais, como depressão, ansiedade e isolamento. (FOUQUET, 2000; DIELS e COMBS, 1997). Objetivo: Investigar os conteúdos psíquicos e os efeitos sociais associados à PFP em sujeitos adultos, realizando uma análise comparativa em três grupos de sujeitos com PFP: nas fases flácida, de recuperação e sequelar. Os resultados obtidos foram utilizados para a elaboração de um roteiro de avaliação fonoaudiológica desses aspectos. Método: Pesquisa de natureza clínica quanti-qualitativa. Casuística: Situação 1 - 16 sujeitos adultos, ambos os sexos, na faixa etária de 43 a 88 anos, com PFP. Situação 2 - Estudo de caso clínico de uma paciente do sexo feminino, 52 anos, com instalação da PFP há 18 anos, com diagnóstico desconhecido e que atualmente apresenta sequelas. Procedimento: Situação 1 - Entrevistas abertas com os sujeitos, a partir da seguinte questão disparadora: Quais foram as consequências da paralisia facial periférica na sua vida social e emocional? . O material foi gravado em áudio e vídeo, transcrito literalmente, sistematizado de acordo com a Análise Categorial proposta por Bardin (2002) e submetidos as frequências estatística descritiva e porcentagens de ocorrência de cada conteúdo psíquico e efeitos sociais. Alguns sujeitos responderam para mais de uma categoria. Situação 2 Terapia fonoaudiológica no período de março de 2010 à julho de 2010 com a descrição dos procedimentos, como Avaliação da Condição Facial, terapêutica miofuncional e conteúdos psíquicos e sociais implicados nessa condição. Resultados e Discussão: Os resultados indicaram que, comparativamente, os sujeitos portadores de sequelas apresentam maior significância estatística de conteúdos psíquicos e efeitos sociais associados à PFP. Seguidos, respectivamente, dos que se encontram nas fases flácida e de recuperação. Os resultados sugerem que o fonoaudiólogo, além de realizar a reabilitação funcional e estética do sujeito acometido pela PFP, precisa ter escuta para aspectos psíquicos e sociais envolvidos nesse quadro clínico, de maneira a avaliar e buscar diminuir o grau de sofrimento psíquico e favorecer a adaptação social desses pacientes. A elaboração de um roteiro com indicadores dos aspectos psíquicos e sociais facilita o acesso dos profissionais a esses conteúdos. Conclusão: A abordagem biopsicosocial dos pacientes acometidos pela PFP revelou vasta, e significativa, gama de conteúdos subjetivos que justificam novos estudos que possam contribuir para a eficácia do método clínico fonoaudiológico na abordagem desse quadro clínico

by Albert Yan Wo Chan. / Thesis (M.D.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 203-242). / Chapter CHAPTER1 --- INTRODUCTION --- p.1 / Chapter 1.1 --- Brief History of thyroid diseases --- p.2 / Chapter 1.2 --- Thyrotoxicosis and muscle diseases --- p.7 / Chapter 1.2.1 --- Thyrotoxic myopathy --- p.8 / Chapter 1.2.2 --- Exophthalmic ophthalmoplegia (Grave's ophthalmopathy) --- p.10 / Chapter 1.2.3 --- Myasthenia gravis --- p.10 / Chapter 1.2.4 --- Thyrotoxic periodic paralysis (TPP) --- p.11 / Chapter 1.2.4.1 --- Overview --- p.11 / Chapter 1.2.4.2 --- Prevalence --- p.13 / Chapter 1.3 --- Periodic paralysis syndromes in the Chinese --- p.16 / Chapter 1.4 --- Potassium homeostasis in TPP --- p.19 / Chapter 1.5 --- Cellular potassium transport --- p.24 / Chapter 1.5.1 --- Role of the sodium pump --- p.24 / Chapter 1.5.2 --- Hormonal control of the sodium pump --- p.26 / Chapter 1.5.3 --- Molecular biology of the sodium pump --- p.27 / Chapter 1.5.4 --- Na-K-Cl transporter --- p.30 / Chapter 1.5.5 --- Summary --- p.32 / Chapter 1.6 --- Mechanism of paralysis --- p.33 / Chapter 1.7 --- Aetiology of TPP --- p.37 / Chapter 1.7.1 --- Genetic predisposition --- p.37 / Chapter 1.7.2 --- Possible membrane defect --- p.38 / Chapter 1.7.3 --- The central role of the sodium pump in the pathogenesis of TPP --- p.39 / Chapter 1.7.4 --- Environmental factor --- p.40 / Chapter 1.7.5 --- Summary --- p.40 / Chapter 1.8 --- Aims of the thesis --- p.41 / Chapter CHAPTER2 --- A PILOT STUDY ON THE PATHOPHYSIOLOGY OF TPP --- p.44 / Chapter 2.1 --- Aim --- p.45 / Chapter 2.2 --- Background --- p.45 / Chapter 2.2.1 --- The measurement of Na-K ATPase/ sodium pump activity --- p.45 / Chapter 2.2.2 --- In vitro decline in plasma potassium concentration --- p.48 / Chapter 2.2.3 --- Catecholamines --- p.49 / Chapter 2.3 --- Subjects & methods --- p.50 / Chapter 2.4 --- Results --- p.51 / Chapter 2.5 --- Discussion --- p.56 / Chapter 2.6 --- Conclusion --- p.58 / Chapter CHAPTER3 --- PLATELET NA-K ATPASE AS A TISSUE MARKER OF HYPERTHYROIDISM --- p.59 / Chapter 3.1 --- Aim --- p.60 / Chapter 3.2 --- Background --- p.60 / Chapter 3.2.1 --- Thyroid function tests (TFTs) --- p.60 / Chapter 3.2.2 --- TFTs vs tissue markers as an index of hyperthyroidism --- p.61 / Chapter 3.2.3 --- Sodium pump activity as a tissue marker and TPP --- p.63 / Chapter 3.2.4 --- Choice of tissue for sodium pump study --- p.64 / Chapter 3.2.5 --- Rationale behind the aim of study --- p.65 / Chapter 3.3 --- Subjects & methods --- p.68 / Chapter 3.3.1 --- Chemicals --- p.68 / Chapter 3.3.2 --- Subjects --- p.68 / Chapter 3.3.3 --- Plasma thyroid hormones analysis --- p.69 / Chapter 3.3.4 --- Determination of platelet Na-K ATPase activity --- p.71 / Chapter 3.3.4.1 --- Principle --- p.71 / Chapter 3.3.4.2 --- Preparation of platelets --- p.73 / Chapter 3.3.4.3 --- Preparation of platelet lysate --- p.73 / Chapter 3.3.4.4 --- Measurement of Na-K ATPase activity --- p.74 / Chapter 3.3.4.5 --- Measurement of Pi --- p.76 / Chapter 3.3.4.6 --- Measurement of protein --- p.78 / Chapter 3.4 --- Statistics & data handling --- p.80 / Chapter 3.5 --- Results --- p.81 / Chapter 3.5.1 --- Development of the platelet Na-K ATPase assay --- p.81 / Chapter 3.5.1.1 --- Introduction --- p.81 / Chapter 3.5.1.2 --- Effect of saponin concentration on the Na-K ATPase activity --- p.81 / Chapter 3.5.1.3 --- Linearity of the Na-K ATPase assay --- p.83 / Chapter 3.5.1.4 --- Imprecision of the Na-K ATPase assay --- p.83 / Chapter 3.5.1.5 --- Linearity of the Pi assay --- p.86 / Chapter 3.5.1.6 --- Linearity of the protein assay --- p.86 / Chapter 3.5.2 --- Thyroid function tests --- p.89 / Chapter 3.5.3 --- Platelet Na-K ATPase activity --- p.92 / Chapter 3.5.4 --- Correlation between thyroid hormones concentrations and platelet Na-K ATPase activity --- p.95 / Chapter 3.5.5 --- Correlation between age and platelet Na-K ATPase activity --- p.95 / Chapter 3.5.6 --- Performance of platelet ATPase as an indicator of hyperthyroidism --- p.99 / Chapter 3.6 --- Discussion --- p.102 / Chapter CHAPTER4 --- BASAL NA-K ATPASE ACTIVITY IN THYROTOXIC SUBJECTS WITH AND WITHOUT HYPOKALAEMIC PERIODIC PARALYSIS --- p.107 / Chapter 4.1 --- Aim --- p.108 / Chapter 4.2 --- Introduction --- p.108 / Chapter 4.2.1 --- Background --- p.108 / Chapter 4.2.2 --- Difficulties and limitations in TPP study --- p.109 / Chapter 4.3 --- Subjects & methods --- p.112 / Chapter 4.3.1 --- Platelet Na-K ATPase --- p.112 / Chapter 4.3.2 --- Rubidium loading test --- p.114 / Chapter 4.4 --- Statistics & data handling --- p.115 / Chapter 4.5 --- Results --- p.117 / Chapter 4.5.1 --- Platelet Na-K ATPase activity --- p.117 / Chapter 4.5.1a --- Thyrotoxic vs TPP --- p.121 / Chapter 4.5.1b --- Thyrotoxic vs euthyroid and TPP vs EuTPP --- p.124 / Chapter 4.5.1c --- Control vs euthyroid and EuTPP --- p.126 / Chapter 4.5.2 --- Rubidium loading test --- p.127 / Chapter 4.6 --- Discussion --- p.129 / Chapter 4.6.1 --- Clinical marker of TPP --- p.129 / Chapter 4.6.2 --- RBC/ lymphocyte sodium pump activity --- p.130 / Chapter 4.6.3 --- Platelet Na-K ATPase activity --- p.135 / Chapter CHAPTER5 --- VALIDATION OF THE ORAL GLUCOSE TOLERANCE TEST --- p.142 / Chapter 5.1 --- Aim --- p.143 / Chapter 5.2 --- Background --- p.143 / Chapter 5.2.1 --- Need for a validated protocol for OGTT --- p.143 / Chapter 5.2.2 --- Effectiveness of sodium fluoride as a preservative of glucose in blood sample --- p.144 / Chapter 5.2.3 --- Effect of delay in sample handling --- p.146 / Chapter 5.2.4 --- Ideal concentration of NaF --- p.147 / Chapter 5.2.5 --- D-mannose as a preservative of blood glucose --- p.147 / Chapter 5.2.6 --- Rationale behind the aim of study --- p.148 / Chapter 5.3 --- Subjects & methods --- p.149 / Chapter 5.3.1 --- Effectiveness of NaF --- p.149 / Chapter 5.3.2 --- Effect of delay in sample handling --- p.150 / Chapter 5.3.3 --- Ideal concentration of NaF --- p.151 / Chapter 5.3.4 --- Evaluation of D-mannose as a preservative of blood glucose --- p.151 / Chapter 5.4 --- Results and discussion --- p.153 / Chapter 5.4.1 --- Effectiveness of NaF --- p.153 / Chapter 5.4.2 --- Effect of delay in sample handling --- p.157 / Chapter 5.4.3 --- Ideal concentration of NaF --- p.159 / Chapter 5.4.4 --- D-mannose as a preservative of glucosein blood --- p.161 / Chapter 5.4.5 --- Summary --- p.167 / Chapter CHAPTER6 --- HYPERINSULINAEMIA AND NA-K ATPASE ACTIVITY IN TPP --- p.168 / Chapter 6.1 --- Aim --- p.169 / Chapter 6.2 --- Background --- p.169 / Chapter 6.2.1 --- "Insulin, hypokalaemia and sodium pump" --- p.169 / Chapter 6.2.2 --- Insulin and skeletal muscle membrane potential --- p.170 / Chapter 6.2.3 --- Potential role of insulin in the pathogenesis of TPP --- p.172 / Chapter 6.2.4 --- Hyperinsulinaemia and thyrotoxicosis --- p.173 / Chapter 6.2.5 --- TPP vs uncomplicating thyrotoxic patients --- p.173 / Chapter 6.2.6 --- Catecholamines and insulin secretion --- p.175 / Chapter 6.3 --- Subjects and methods --- p.177 / Chapter 6.4 --- Statistics and data handling --- p.179 / Chapter 6.5 --- Results --- p.180 / Chapter 6.6 --- Discussion --- p.187 / Chapter CHAPTER7 --- OVERALL DISCUSSION AND CONCLUSION --- p.192 / Chapter 7.1 --- General discussion --- p.193 / Chapter 7.2 --- Role of sodium pump in the pathogenesis of TPP --- p.196 / Chapter 7.3 --- Strategy for further study --- p.201 / Chapter 7.4 --- Conclusion --- p.202 / REFERENCES --- p.203 / APPENDIX --- p.239 / (Selected publications)

A paralisia facial é uma patologia de etiologia ampla, com prejuízos múltiplos e severos aos indivíduos afetados. Dentre os tratamentos cirúrgicos atualmente propostos a reanimação facial com retalho de músculo temporal se posiciona intermediariamente no espectro de complexidade. Neste estudo objetivou-se a identificação dos resultados com seu uso em nossa disciplina, pela revisão dos prontuários dos pacientes acometidos de tal patologia nos últimos 17 anos. Dos 152 prontuários avaliados, 93 se enquadravam nos critérios de inclusão. Destes, 36 casos com paralisia facial periférica completa foram passíveis de estudo, correspondendo a 39% dos casos de transposição. Os resultados foram uma predominância de pacientes do sexo feminino (26) em relação ao sexo masculino (10). A reanimação conjunta de pálpebra e boca com a transposição do músculo temporal correspondeu a 16 casos; pálpebra a 12 casos; e boca a 8 casos. Nos casos com transplante muscular microcirúrgico, o músculo grácil foi utilizado. A média de procedimentos ancilares das pacientes do sexo feminino foi superior a do sexo masculino. Alterações da técnica da transposição do músculo temporal foram observadas em casos a partir de 2001, com a neurotização muscular por enxerto transfacial de nervo sural em 9 casos. A técnica utilizada em nosso serviço se baseia no retalho de Gillies, mas com utilização da própria fáscia do temporal para seu alongamento, tanto para o tratamento das pálpebras como da boca. A neurotização do músculo temporal como descrita é inédita na literatura, e passível de futura comparação de resultados com as técnicas mais atuais. / Facial palsy is pathology with a great number of causes, with important deficits to the patients. Among the surgical treatments used, the facial reanimation with temporalis muscle flap is a medium complexity procedure. This study intended to identify the results gained with this procedure in our division, analyzing the data of the patients who underwent the temporalis muscle transposition in the last 17 years. One hundred fifty two cases were reviewed, with 93 fulfilling the inclusion criteria. From these, 36 cases of complete facial paralysis reviewed, corresponding to 39% of the whole. Results showed a higher incidence of women in the study, with 26 against 10 men. Motion reanimation of the eyelids and mouth together with the temporalis transposition corresponded to 16 cases, 12 cases were to reanimation of the eyelids only, and eight cases to the mouth. When free muscle transplant was used for facial reanimation, all the cases were done with the gracilis muscle flap. Women had a higher rate of surgeries compared to men. Modifications of the procedure were observed in recent cases, after 2001. Neurotization of the transposed temporalis muscle flap was achieved with a cross-face sural nerve graft in 9 cases. The temporalis transposition technique used I our division is based on the Gillies? one, but using the temporalis fascia to make the flap longer. The temporalis muscle neurotization used wasn?t find in the literature, promising good results in future controlled prospective comparisons.

Made available in DSpace on 2016-08-19T18:15:55Z (GMT). No. of bitstreams: 1 ANA EUGENIA RIBEIRO DE ARAUJO E ARAUJO.pdf: 1138893 bytes, checksum: 86e944da346d6667f00a4a6ed7a7fdec (MD5) Previous issue date: 2007-08-20 / Cerebral Paralysis (CP) comprehends a series of non progressive syndromes of motor and posture disturbances, resulting from irreversible damage to the developing central nervous system. The hippotherapy is a therapeutical and educational method that uses a horse in an interdisciplinary approach attempting to enhance the posture stability in children affected by Cerebral Paralysis (CP). This work aim is to evaluate the benefits PC diagnosed children can attain after one year participation in an hippotherapy program. 27 spastic diplegia PC diagnosed children were studied (15 boys and 17 girls) ranging from 2 to 12 years of age. As to evaluate the following body parts: head and neck, shoulders and scapulae, trunk, vertebral column and pelvis, before and after hippotherapy treatment, a scale, standardized by the interdisciplinary medical team of the hippotherapy center, was used. The program was conducted once a week, in sessions of 45 minutes each. There were verified posture benefits statistically significant (p<0.05) in all body parts, especially in those presenting the worst asymmetry conditions before the treatment, such as the trunk and pelvis. One can conclude stating that the hippotherapy treatment positively influenced the posture adjustment as well as the children s static and dynamic equilibrium, thus improving their motor abilities and contributing to the walking prediction. / A Paralisia Cerebral (PC) compreende uma série de síndromes não progressivas de distúrbios motores e de postura, resultantes de um dano irreversível no sistema nervoso central em desenvolvimento. A Equoterapia é um método terapêutico e educacional que utiliza o cavalo dentro de uma abordagem interdisciplinar, visando melhorar a estabilidade postural em crianças com Paralisia Cerebral (PC). Objetivou-se avaliar os benefícios posturais em crianças com paralisia cerebral (PC) após a participação num programa de equoterapia durante um ano. Estudou-se vinte e sete crianças (quinze meninos, doze meninas) diagnosticadas com Paralisia Cerebral espástica diplegica, com idade entre 2 a 12 anos. Utilizou-se uma escala padronizada pela equipe interdisciplinar do centro de equoterapia para avaliar a postura dos seguintes segmentos corporais: cabeça e pescoço, ombros e escápula, tronco, coluna vertebral e pélvis, antes e depois da equoterapia. O programa aconteceu uma vez por semana, numa sessão de 45 minutos. Verificou-se benefícios posturais estatisticamente significantes (p<0,05) em todos os segmentos corporais, especialmente naqueles que apresentaram as piores condições de assimetria antes do tratamento, como o tronco e pélvis. Concluiu-se que a equoterapia influenciou positivamente no ajuste postural assim como no equilíbrio estático e dinâmico da criança, aprimorando desta forma, suas habilidades motoras e contribuindo para o prognóstico de marcha.

In my research, I will examine James Joyce’s Dubliners as a collection of stories that is unified by an ongoing theme; escape or the desire to escape. In the collection, the want or need to escape serves a major purpose throughout the characters and their lives. This thesis explores five stories that share this theme in particular: “The Sisters,” “Eveline,” “Araby,” “An Encounter,” and “The Dead.” Each story will be discussed in the context of how each story progresses from a want to an actual escape. In addition, the thesis also considers how these stories exhibit a progression towards isolation and paralysis in the living until the final story, “The Dead.” “The Dead” can be interpreted as a positive, hopeful ending to the bleak collection, but I will argue its ending is anything but optimistic along with its crucial role as a conclusion to Dubliners.

Hyperkalemic periodic paralysis is characterized by myotonic discharges followed by paralysis. Caused by a mutation in the gene encoding for NaV1.4 channel, patients do not experience symptoms during infancy, but the onset starts between 1-10 years of age. The symptoms severity then increases with age until adolescence. A large increase in gene expression marked by an increase in oxidative capacity of muscles has also been reported in HyperKPP. It is possible that the onset of symptoms is related solely to NaV1.4 channel content/activity reaching a critical level. It is also possible that the onset of some symptoms are due to defective NaV1.4, while other symptoms and the increase in severity with age are related to changes in membrane components as a result of changes in gene expression. To test these possibilities, the progression of paralysis and changes in fiber types were followed with age in HyperKPP mice in relation to changes in NaV1.4 content and activity. Changes in fiber types (index of changes in gene expression), started after the onset of paralysis was observed, which coincided with NaV1.4 channels reaching maximum expression. Therefore, the onset of symptoms was related to defective NaV1.4 channels.