O uso de robôs como auxiliares na reabilitação, tanto para ganho de função, como para auxiliar na realização de atividades, é encontrado na literatura em estudos envolvendo acidente vascular encefálico. Diversos dispositivos robóticos têm sido desenvolvidos ao longo da última década para oferecer treinamento sensório-motor direcionado para pacientes com doenças neurológicas, como acidente vascular encefálico, propiciando melhora no desempenho motor dos membros superiores nesta população. Poucos estudos são encontrados sobre o uso de robôs em lesão do plexo braquial ou lesão na medula espinhal. Além disso, há pouca produção nacional relacionada a esse tema. Esse trabalho objetivou-se avaliar o uso de um instrumento robótico, Robô MOREw, que foi desenvolvido pela Escola de Engenharia de São Carlos - EESC - USP com o intuito de facilitação e ganho nos movimentos de flexão e extensão de punho. Dessa forma, pretendia-se a verificação do funcionamento do robô como auxiliar de reabilitação através de testes clínicos e sua aplicabilidade com indivíduos que sofreram lesão do plexo braquial ou lesão na medula espinhal. A metodologia escolhida é de Projeto de Produto que utiliza como proposta a divisão do projeto em quatro fases, sendo estas: projeto informacional, projeto conceitual, projeto preliminar e projeto detalhado. Foi dado enfoque ao projeto detalhado em testes de laboratório e clínicos para verificação do funcionamento e aplicabilidade do robô com voluntários. O estudo foi composto por 2 fases: FASE 1 - Adequação do MOREw: 10 participantes sem comprometimentos nos membros superiores e sem lesões associadas verificaram o funcionamento do robô. Após isso, modificações necessárias foram efetuadas. FASE 2 - Aplicabilidade do MOREw: Teste com 5 participantes que apresentaram diminuição do movimento no Membro Superior, sendo 3 com lesão do plexo braquial e 2 com lesão na medula espinhal que jogaram por 30 minutos uma vez por semana, durante 12 semanas. Nos resultados notou-se que as adequações do robô MOREw foram de extrema importância para o funcionamento adequado do equipamento robótico utilizado por sujeitos com limitação dos movimentos de membros superiores, tanto em relação à ergonomia, funcionamento do jogo e possibilidades de ajustes em programas de reabilitação. Os sujeitos que fizeram uso por 3 meses referiram grande satisfação, motivação e demonstraram maior empenho na reabilitação com o auxílio robótico, que foram corroborados pelos testes funcionais que apresentaram discreta melhora em relação à Amplitude de Movimento e Força Muscular dos membros superiores, além da melhora na pontuação na Escala Específica do Paciente. Assim, MOREw é uma opção a ser utilizada na reabilitação com sujeitos com LM e LPB. / The use of robots as aid in rehabilitation to gain function or to assist in activities performance is found in the literature involving stroke. Several robotic devices have been developed over the last decade to provide sensory-motor training in patients with neurological diseases such as stroke, leading to improvement in motor performance of the upper limbs in this population. Few studies using robot assistance are found in injuries like brachial plexus (BPI) or spinal cord (SCI). In addition, there is little national production related to this topic. The aim of this work was to evaluate the use of a robotic instrument, Robot MOREw, which was developed by the Engineering School of São Carlos - EESC - USP with the purpose to facilitate and/or gain wrist flexion and extension movements. Thus, it was intended to verify the functioning of the robot as a rehabilitation aid through clinical tests, and its applicability with individuals who suffered BPI or SCI. The methodology chosen was the Project Product Design that consists of four phases: informational, conceptual, preliminary and detailed project. This study focuses on the detailed project, which was tested at laboratory as well as with volunteers in clinical trials to verify the robot applicability and operation. The study consisted of 2 phases: Phase 1 - Adequacy: 10 participants with no involvement in the upper limbs and without associated lesions verified the robot functionality. After that, changes were made to the equipment. Phase 2 - Applicability: Tested with 5 participants who had decreased movement in the Upper Limb, 3 with BPI and 2 with SCI, using it 30 min once a week for 12 weeks. It was noticed that the MOREw adjustments were of extreme importance for the correct functionality of the equipment that was used by clients with upper limb deficit movements, regarding ergonomics aspects, game functioning and rehabilitation programs adjustments. The clients who used it for 3 months reported great satisfaction, motivation and demonstrated greater commitment to rehabilitation with robotic assistance, confirmed by functional tests that showed a slight improvement in relation to the range of motion and muscular strength of the upper limbs, besides the improvement on the Patient Specific Scale. MOREw can be an option for BPI and SCI rehabilitation.

No description available.

Wiederkäuer können entsprechend ihrer Ernährungsgewohnheiten in Rauhfutterfresser, Konzentrat-selektierer und Intermediärtypen eingeteilt werden (HOFMANN 1989). Diese verschiedenen Ernährungstypen spiegeln sich in anatomischen Unterschieden des gesamten Gastrointestinaltraktes, insbesondere jedoch in der Vormagenanatomie wider. Ziel der vorliegenden Arbeit war es, die intrinsische Innervation des Pansens von Wiederkäuern des Rauhfutterfresser- und Intermediärtyps näher zu charakterisieren und mögliche Unterschiede zwischen diesen beiden Ernährungstypen aufzuzeigen. Dafür wurden im ersten Teil der Arbeit die Expression des generellen Neuronenmarkers HuC/D, der Syntheseenzyme Stickstoffmonoxidsynthase (NOS) und Cholinazetyltransferase (ChAT), sowie der Neuropeptide und der neuronalen Marker Neuropeptid Y (NPY), Vasoaktives Intestinales Peptid (VIP), Somatostatin (SOM) und Calbindin (Calb) an Häutchenpräparaten (whole mounts) des myenterischen Plexus aus dem Pansen der Rauhfutterfresser Schaf und Rind und der Intermediärtypen Ziege und Damwild immunhistochemisch untersucht. Desweiteren wurden die Parameter Gangliengröße (Neurone/Ganglion), Gangliendichte (Ganglien/cm² Plexusfläche) und Neuronendichte (Neurone/cm² Plexusfläche) der genannten Spezies tierartlich vergleichend erfasst. Beim Rind fanden sich mit 73±6 Neuronen/Ganglion (Mittelwert ± Standardabweichung) signifikant größere Ganglien als bei den kleinen Wiederkäuern Ziege (57±19), Damwild (51±20) und Schaf (45±18). Demgegenüber war die mittlere Gangliendichte beim Rind mit 6±1 Ganglien/cm² Plexusfläche signifikant geringer als bei Schaf (8±2) und Ziege (10±3), die wiederum eine signifikant geringere Gangliendichte als das Damwild mit 15±3 Ganglien/cm² Plexusfläche aufwiesen. Die Neuronendichte war im ventralen Pansensack von Damwild und Ziege (664±194 bzw. 584±295 Neuronen/cm² Plexusfläche) signifikant höher als beim Schaf (289±132). Die Neuronendichte des Rindes lag mit 432±238 Neuronen/cm² Plexusfläche zwischen den Werten der anderen Spezies. Alle untersuchten myenterischen Neurone waren entweder cholinerg oder nitrerg kodiert. Der relative Anteil nitrerger Neurone pro Ganglion war bei der Ziege (44±10 %) signifikant höher als beim Schaf (30±8 %). Dementsprechend war der relative Anteil cholinerger Neurone beim Schaf signifikant höher als bei der Ziege. Neben den Anteilen unterschied sich auch die Verteilung der nitrergen Neurone in den myenterischen Ganglien. Bei Rind und Ziege waren diese in Clustern am Rand der Ganglien angeordnet, während sie bei Schaf und Damwild locker über die Ganglienfläche verteilt erschienen. Mit Hilfe von Kolokalisationsuntersuchungen konnten bei allen untersuchten Spezies folgende Hauptneuronenpopulationen nachgewiesen werden: ChAT/SP>NOS/NPY/VIP>>ChAT/- und NOS/NPY. Dabei war die cholinerge Hauptpopulation ChAT/SP beim Schaf mit 67±7 % aller myenterischen Neurone signifikant stärker ausgeprägt als beim Damwild (58±11 %), während die nitrerge Hauptpopulation NOS/NPY/VIP bei der Ziege mit 40±9 % signifikant stärker als beim Schaf (26±6 %) ausgeprägt war. SOM und Calbindin fanden sich nur in einer sehr geringen Anzahl (vornehmlich cholinerger) Neurone, wobei SOM–positive Somata nur bei Damwild und Schaf nachgewiesen werden konnten. Im myenterischen Plexus von Rind und Ziege fanden sich ausschließlich Somatostatin-positive Nervenfasern. Im zweiten Teil der Arbeit wurden die Reaktionen von Zirkulärmuskelstreifen aus dem ventralen Pansensack von Schaf und Ziege auf Elektrische Feldstimulation nach Zugabe von Atropin bzw. L-NAME (NG-Nitro-L-Arginine Methylester Hydrochlorid), sowie die Reaktionen auf steigende Konzentrationen von Carbachol funktionell untersucht. Bei beiden Spezies führte Atropin zu verminderten, L-NAME zu verstärkten Kontraktionen als Reaktion auf Elektrische Feldstimulationen. Der muskarinerge Agonist Carbachol führte im Schaf- und Ziegenpansen zu einer konzentrationsabhängigen Steigerung der Motilität. Die Ergebnisse der neurochemischen Untersuchungen lassen auf eine stärkere cholinerge (und somit exzitatorische Kontrolle) des Pansens des Rauhfutterfressers Schaf im Vergleich zu Ziege und Damwild (Intermediärtypen) schließen. Die mikrobielle Fermentation grob strukturierten Rauhfutters erfordert starke, mixende Pansenkontraktionen. Es ist zu vermuten, dass ein höherer Anteil cholinerger myenterischer Neurone auch stärkere Pansenkontraktionen ermöglicht. Somit wäre die starke Ausprägung der cholinergen Innervation im Pansen des Rauhfutterfressers Schaf als eine Anpassung an die physikomechanischen Eigenschaften der bevorzugten Nahrungsquelle Gras zu sehen. Allerdings gelang es in der vorliegenden Arbeit nicht, diese Hypothese durch Unterschiede der in-vitro Motilität an ovinen und caprinen Pansenmuskelstreifen zu untermauern. In scheinbarem Widerspruch zu dieser Hypothese stand auch die nur gering ausgeprägte cholinerge Dominanz bei dem untersuchten großen Rauhfutterfresser Rind. Allerdings könnte diese genetisch bedingt sein, da es sich bei den untersuchten Proben um Material von auf hohe Milchleistung (und damit Konzentratverdaulichkeit) gezüchteten Rinderrassen handelte. Auch ein direkter diätetischer Einfluss auf die intrinsische Panseninnervation scheint in diesem Zusammenhang denkbar. Diese Annahme gründet sich auf Untersuchungen an kleinen Labornagern, bei denen die Aufnahme hoher Energiemengen zu einem Verlust enterischer cholinerger Neurone – und somit zu einem relativ höheren Anteil nitrerger Neurone führt. Deshalb sollte bei allen untersuchten Spezies neben einem möglichen genetischen Einfluss auch der Einfluss der Fütterung nicht außer Acht gelassen werden. Klarheit könnte hier neben vergleichenden Untersuchungen an Extensiv- und Hochleistungsrinderrassen auch die Untersuchung des Einflusses von bestimmten Fütterungsregimen auf die enterische Panseninnervation bringen.

Le système nerveux autonome cardiaque est devenu une cible dans les thérapies ablatives de la fibrillation auriculaire. Nous avons étudié les voies de communication et la fonction des plexus ganglionnaires (PG) de l'oreillette gauche (PGOG) afin de clarifier la validité physiopathologique des méthodes de détection et des thérapies impliquant ces groupes de neuronnes. Méthodes: Vingt-deux chiens ont subi une double thoracotomie et ont été instrumentés avec des plaques auriculaires épidcardiques de multiélectrodes. Une stimulation électrique (2 mA, 15 Hz) des PGOG a été réalisée à l'état basal et successivement après: 1) une décentralisation vagale, 2) l'ablation par radiofréquence des plexus péri-aortiques et de la veine cave supérieure (Ao/VCS) et 3) l'ablation du PG de l'oreillette droite (PGOD). Ces procédures de dénervation ont été réalisées suivant une séquence antérograde (n = 17) ou rétrograde (n = 5). Résultats: Chez 17 des 22 animaux, la stimulation des PGOG a induit une bradycardie sinusale (149 ± 34 bpm vs 136 ± 28 bpm, p < 0.002) et des changements de repolarization (ΔREPOL) auriculaires isointégrales. Dans le groupe des ablations antérogrades, les réponses aux stimulations vagales ont été supprimées suite à la décentralisation vagale chez un seul animal, par l'ablation des plexus Ao/VCS dans 4 cas et par l'ablation du PGOG dans 5 autres animaux. Des changements ont persisté tout au long chez 2 chiens. La valeur de surface des ΔREPOL a diminué avec les dénervations séquentielles, passant de 365 ± 252 mm2 en basale à 53 ± 106 mm2 après l'ablation du PGOD (p < 0.03). Dans le groupe de dénervation rétrograde, les changements de repolarisation et chronotropiques ont été supprimés suite à l'ablation du PGOD chez deux chiens et suite à l'ablation Ao/VCS chez trois. La valeur de surface du ΔREPOL a aussi diminué après l'ablation du PGOD (269±144mm2 vs 124±158mm2, p<0.05). Conclusion: Les PGOD sont identifiables en préablation par la réponse bradycardique à la stimulation directe dans la plupart des cas. Le PGOD semble former la principale, mais non la seule, voie de communication avec le nœud sinusal. Ces résultats pourraient avoir des implications dans le traitement de la FA par méthodes ablatives. / The cardiac autonomic nervous system has recently become the target of ablative therapy in the treatment of atrial fibrillation. We investigated the pathways and function of the left atrial ganglionated plexus (LAGP) to clarify the pathophysiologic validity of therapies involving this cluster of neurons. Methods: Twenty-two bilaterally thoracotomized canines were instrumented with atrial epicardial plaques. LAGP stimulation was performed in the basal state and successively following 1) vagal decentralization, 2) radiofrequency ablation of the peri-aortic/superior vena caval (Ao/SVC) plexi, and 3) of the right atrial ganglionated plexus (RAGP). Denervation was carried out in either the aforementioned order (n=17, antegrade) or reversed (n=5, retrograde). Results: In 17 of 22 animals, LAGP stimulation induced a sinus bradycardia (149±34bpm to 136±28bpm, p<0.002) and atrial isointegral repolarization changes (REPOL∆). In the antegrade group, response was suppressed by vagal decentralization (n=1), Ao/SVC plexi ablation (n=4), and RAGP ablation (n=5). Changes persisted throughout in 2 canines. Surface area of REPOL∆ diminished with successive denervation, from 365±252 at baseline to 53±106mm2 following RAGP ablation (p<0.03). With retrograde denervation, chronotropic and repolarisation changes were suppressed following RAGP ablation in two canines, and following Ao/SVC ablation in three. Surface area of REPOL∆ diminished following RAGP ablation as well (269±144mm2 vs 124±158mm2, p<0.05). Conclusion: The LAGP can be identified intraoperatively by the bradycardic response to direct stimulation in most cases. The RAGP appears to be the primary, but not the only, gateway to the sinus node. These results could have important clinical implications relating to ablative treatment of atrial fibrillation.

Le système nerveux autonome cardiaque est devenu une cible dans les thérapies ablatives de la fibrillation auriculaire. Nous avons étudié les voies de communication et la fonction des plexus ganglionnaires (PG) de l'oreillette gauche (PGOG) afin de clarifier la validité physiopathologique des méthodes de détection et des thérapies impliquant ces groupes de neuronnes. Méthodes: Vingt-deux chiens ont subi une double thoracotomie et ont été instrumentés avec des plaques auriculaires épidcardiques de multiélectrodes. Une stimulation électrique (2 mA, 15 Hz) des PGOG a été réalisée à l'état basal et successivement après: 1) une décentralisation vagale, 2) l'ablation par radiofréquence des plexus péri-aortiques et de la veine cave supérieure (Ao/VCS) et 3) l'ablation du PG de l'oreillette droite (PGOD). Ces procédures de dénervation ont été réalisées suivant une séquence antérograde (n = 17) ou rétrograde (n = 5). Résultats: Chez 17 des 22 animaux, la stimulation des PGOG a induit une bradycardie sinusale (149 ± 34 bpm vs 136 ± 28 bpm, p < 0.002) et des changements de repolarization (ΔREPOL) auriculaires isointégrales. Dans le groupe des ablations antérogrades, les réponses aux stimulations vagales ont été supprimées suite à la décentralisation vagale chez un seul animal, par l'ablation des plexus Ao/VCS dans 4 cas et par l'ablation du PGOG dans 5 autres animaux. Des changements ont persisté tout au long chez 2 chiens. La valeur de surface des ΔREPOL a diminué avec les dénervations séquentielles, passant de 365 ± 252 mm2 en basale à 53 ± 106 mm2 après l'ablation du PGOD (p < 0.03). Dans le groupe de dénervation rétrograde, les changements de repolarisation et chronotropiques ont été supprimés suite à l'ablation du PGOD chez deux chiens et suite à l'ablation Ao/VCS chez trois. La valeur de surface du ΔREPOL a aussi diminué après l'ablation du PGOD (269±144mm2 vs 124±158mm2, p<0.05). Conclusion: Les PGOD sont identifiables en préablation par la réponse bradycardique à la stimulation directe dans la plupart des cas. Le PGOD semble former la principale, mais non la seule, voie de communication avec le nœud sinusal. Ces résultats pourraient avoir des implications dans le traitement de la FA par méthodes ablatives. / The cardiac autonomic nervous system has recently become the target of ablative therapy in the treatment of atrial fibrillation. We investigated the pathways and function of the left atrial ganglionated plexus (LAGP) to clarify the pathophysiologic validity of therapies involving this cluster of neurons. Methods: Twenty-two bilaterally thoracotomized canines were instrumented with atrial epicardial plaques. LAGP stimulation was performed in the basal state and successively following 1) vagal decentralization, 2) radiofrequency ablation of the peri-aortic/superior vena caval (Ao/SVC) plexi, and 3) of the right atrial ganglionated plexus (RAGP). Denervation was carried out in either the aforementioned order (n=17, antegrade) or reversed (n=5, retrograde). Results: In 17 of 22 animals, LAGP stimulation induced a sinus bradycardia (149±34bpm to 136±28bpm, p<0.002) and atrial isointegral repolarization changes (REPOL∆). In the antegrade group, response was suppressed by vagal decentralization (n=1), Ao/SVC plexi ablation (n=4), and RAGP ablation (n=5). Changes persisted throughout in 2 canines. Surface area of REPOL∆ diminished with successive denervation, from 365±252 at baseline to 53±106mm2 following RAGP ablation (p<0.03). With retrograde denervation, chronotropic and repolarisation changes were suppressed following RAGP ablation in two canines, and following Ao/SVC ablation in three. Surface area of REPOL∆ diminished following RAGP ablation as well (269±144mm2 vs 124±158mm2, p<0.05). Conclusion: The LAGP can be identified intraoperatively by the bradycardic response to direct stimulation in most cases. The RAGP appears to be the primary, but not the only, gateway to the sinus node. These results could have important clinical implications relating to ablative treatment of atrial fibrillation.

Deep brain stimulation (DBS) is a neurosurgical intervention now established for the treatment of movement disorders. For the treatment of chronic pain refractory to medical therapies, several prospective case series have been reported, but few centres worldwide have published findings from patients treated during the last decade using current standards of technology. This thesis seeks to survey the current clinical status of DBS for pain, investigate its mechanisms and their interactions with autonomic function, its clinical limitations and ablative alternatives. Presented first is a review of the current status of analgesic DBS including contemporary clinical studies. The historical background, scientific rationale, patient selection and assessment methods, surgical techniques and results are described. The clinical outcomes of DBS of the sensory thalamus and periventricular / periaqueductal grey (PAVG) matter in two centres are presented including results from several pain and quality of life measures. A series of translational investigations in human subjects receiving DBS for pain elucidating mechanisms of analgesic DBS and its effects upon autonomic function are then presented. Single photon emission tomography comparing PAVG, VP thalamus and dual target stimulation is described. Somatosensory and local field potential (LFP) recordings suggesting PAVG somatotopy are shown. ABPM results demonstrating changes with PAVG DBS are given and Portapres studies into heart rate variability changes with ventral PAVG DBS are detailed. Investigations using naloxone are then shown to hypothesise separate dorsal opioidergic and ventral parasympathetic analgesic streams in the PAVG. Finally, cingulotomy in lung cancer to relieve pain and dyspnoea results are discussed in the context of altering pain and autonomic function by functional neurosurgery. Pain and autonomic interactions and mechanisms in deep brain surgery for pain are then discussed alongside its limitations with proposals made for optimising treatment and improving outcomes.

The goal of this diploma thesis is to build up a methodology of speech techniques for a specific class which is covered in the topic "Prehistory". In the theoretical part I am engaged in particular teaching stages of speech technique such as attitude, respiration, vibration, effort of muscles in solar plexus area and enunciation. I mention its teaching problems and differences of teaching of individual speech techniques lectors. In the practical part of the theses I introduce my own methodology of particular lessons which concur and I cap it with a phonetic (voice) warm-up. I have taught these lessons at grade 3 of a primary school and I have reflected them.

Plus de 50 % des handicaps neurodéveloppementaux sont dus à une exposition périnatale à des stress toxiques ou oxydants. Comprendre comment le cerveau est protégé au cours du développement périnatal et pourquoi ses mécanismes de défense sont dépassés lorsque l’enfant est soumis à un stress important est donc crucial. La barrière sang – liquide céphalorachidien (LCR), localisée au niveau des plexus choroïdes, présente une capacité de détoxification élevée et pourrait donc avoir un rôle prépondérant dans la protection du cerveau au stade périnatal. Nous avons étudié la capacité de plusieurs enzymes choroïdiennes à protéger l'environnement liquidien cérébral pendant la période postnatale chez le rat, et évalué si leurs activités pouvaient être induites par la voie du nuclear factor erythroid-2-related factor 2 (Nrf2). Le facteur Nrf2 peut en effet moduler l’expression de différents gènes codant pour des enzymes de détoxification. Nous avons montré que les glutathion transférases (Gst) et les glutathion peroxydases (Gpx), intervenant respectivement dans l’inactivation des molécules toxiques et dans la régulation du stress oxydant, présentaient des activités choroïdiennes élevées pendant la période postnatale, et avons caractérisé fonctionnellement leur capacités de neuroprotection. Le traitement des ratons avec du diméthylfumarate (DMF), inducteur de la voie Nrf2, induit la migration nucléaire de Nrf2, augmente l’activité choroïdienne Gst, et réduit de 40 % le passage cérébral de toxiques substrats des Gst. Ces données montrent la capacité neuroprotectrice précoce des plexus choroïdes, et indique qu’elle peut être induite pharmacologiquement / More than 50 % of intellectual or sensory-motor deficits in children are due to perinatal exposure to oxidative stress or toxicants. Understanding brain protection mechanisms during development is crucial to design therapeutic strategies to address these disabilitating disorders. The choroid plexuses, forming an interface between the blood and the cerebrospinal fluid (CSF), have a high detoxifying capacity, suggesting their involvement in neuroprotection. The nuclear factor erythroid-2-related factor 2 (Nrf2) pathway can modulate the expression of several genes encoding for antioxidant proteins and detoxifying enzymes. We studied the ability of several choroidal enzyme families to protect the brain fluid environment during the postnatal period in rat and explored whether this protection can be enhanced by Nrf2 pathway. We focused on glutathione transferases (Gsts), which conjugate toxic compounds to glutathione, and glutathione peroxidases (Gpxs), which detoxify reactive oxygen species. Gst and Gpx specific activities were high during the postnatal period in choroid plexuses compared to the cerebral cortex, and their neuroprotective functions were efficient. The Nrf2 factor is expressed in choroid plexuses during the perinatal period. Treatment of rat pups with Nrf2 activator dimethylfumarate induced Nrf2 nuclear translocation and increased Gst activities in choroid plexus tissues. The dimethylfumarate treatment resulted in a large decrease of the blood-to-CSF permeability of a prototypical Gst substrate. These data substantiate the early neuroprotective functions of choroid plexuses, which can be enhanced upon treatment with clinically used pharmacological compounds

INTRODUÇÃO: O plexo braquial é uma rede de estruturas nervosas responsáveis pela inervação motora e sensitiva do membro superior. Os métodos por imagem são de importância fundamental para a complementação diagnóstica tanto na localização como na caracterização do tipo de lesão que acomete o plexo braquial. O objetivo deste trabalho foi avaliar a eficácia do exame de ultrassonografia (US) na visualização do plexo e avaliar o método comparativamente à ressonância magnética (RM). MATERIAL E MÉTODOS: Este é um trabalho prospectivo comparativo entre US e RM na avaliação da anatomia do plexo braquial direito e esquerdo de 20 voluntários normais, totalizando 40 plexos braquiais. Os exames foram realizados no Instituto de Radiologia - Hospital das Clínicas da Faculdade de Medicina da USP. O grupo estudado foi constituído por 10 homens e 10 mulheres, com idades entre 33 e 68 anos (mediana = 42,5 anos, média = 47,2 anos). O estudo de US foi realizado utilizando transdutor linear multifrequencial (13-5 mHz) e o de RM com equipamento em alto campo magnético (1,5 T), utilizando bobina de superfície. O plexo braquial foi dividido em segmentos para estimar a frequência de visualização de cada um em ambos os métodos de diagnóstico por imagem: 1) foraminal (raízes nervosas), 2) espaço interescaleno (junção das raízes nervosas até a formação dos troncos); 3) espaço costoclavicular, correspondendo à região supra e infraclaviculares (troncos e divisões anterior e posterior, cordas); 4) espaço retropeitoral menor (cordas). RESULTADOS: As raízes cervicais juntamente com os troncos superior e médio foram as estruturas que apresentaram maior grau de visualização pelo US. Na RM a maioria das estruturas, com exceção das divisões do plexo, apresentaram excelente grau de visualização. Na análise de equivalência entre os observadores de US e RM, as raízes cervicais de C6, C7 e o tronco médio bilateral apresentaram grau de visualização equivalentes com alta concordância. Nos demais segmentos não houve equivalência na visualização entre os observadores, atentando para menor visualização pelo observador do US. CONCLUSÃO: O método de US consegue avaliar de forma eficaz o segmento proximal do plexo braquial que compreende as saídas das raízes cervicais de C5, C6 e C7, assim como os troncos superior e médio na região lateral do pescoço. O método não é adequado para visualizar as raízes de T1, as divisões anterior e posterior e consegue avaliar de forma parcial e limitada as raízes de C8, tronco inferior e as cordas medial, lateral e posterior do plexo braquial nos espaços costoclavicular e retropeitoral menor / INTRODUCTION: The brachial plexus is a network of neural structures responsible for sensory and motor innervation of the upper limb. The imaging methods are of fundamental importance for diagnostic reasons both in location and in the characterization of the lesion affecting the brachial plexus. The aim of this study was to assess the degree of effectiveness of the ultrasound examination in view of the segments of brachial plexus and assess the value of the method compared to MRI. MATERIAL AND METHODS: This is a prospective study of comparison between US and MRI, studying the anatomy of the right and left sides of brachial plexus in 20 volunteers, totaling 40 plexuses. The exams were performed in the Institute of Radiology - Hospital das Clínicas University of São Paulo Medical School (FMUSP). The study group consisted of 10 men and 10 women, aged 33-68 years (median = 42.5 years, mean = 47.2 years). The U.S. study was performed using a multifrequency linear transducer (13-5 MHz) and MRI equipment in high magnetic field (1.5 T) using a surface coil. The brachial plexus was divided into segments to estimate the frequency of visualization and comparison with MRI: 1) foramen (nerve roots), 2) interscalene space (junction of the nerve roots to the formation of the trunks) 3) costoclavicular space, corresponding to supra and infra-clavicular (trunks and anterior and posterior divisions, cords), 4) retropectoralis minor space (cords). RESULTS: The cervical roots along with the superior and middle trunks were the structures that showed better visualization degree by the US. On MRI, most structures, except for the anterior and posterior divisions of plexus, showed excellent visualization degree. In the analysis of equivalence between the US and MRI of the cervical roots C6, C7 and bilateral upper and middle trunk showed equivalent degree of visualization. In other segments there was equivalence in view among observers, always towards lower viewing by the observer from the US. CONCLUSION: US can effectively assess the proximal segment of the brachial plexus comprising outlet cervical roots C5, C6 and C7, as well as the upper and middle trunk in the lateral neck and partial and limited visualization of other brachial plexus segments in the costo-clavicular and retropectoralis minor spaces

O objetivo desta pesquisa foi quantificar os neurônios mioentéricos do jejuno e do colo durante o desenvolvimento pós-natal de ratos Wistar utilizando morfometria com enfoque estereológico e analisar as mudanças na área ocupada por neurônios e axônios mediante Sistemas de Informação Geográfica (SIG). Foram usadas 20 fêmeas de ratos da linhagem Wistar, divididas em grupos de acordo com a idade pós-natal em dias (G0, G7, G21 e G60). A análise morfométrica foi realizada em preparados totais de membrana usando azul cuprolínico, histoquímica para acetilcolinesterase (AChE) e NADPH-diaforase (NADPH-d), e imuno-histoquímicas para VIP e substância P. Foram estimadas a densidade numérica neuronal/área de superfície serosa, o número total de neurônios por segmento e a área neuronal média. A análise da área ocupada por neurônios e axônios foi realizada a partir de imagens de NADPH-d e AChE. Ocorreu uma diminuição significativa na densidade neuronal/área, nos neurônios totais e nos neurônios nitrérgicos a partir de G7 no jejuno e de G0 no colo, e nos neurônios colinérgicos entre G0 e G7 no jejuno e G0 e G21 no colo. O número total de neurônios corados com azul cuprolínico aumentou significativamente no colo a partir de G7; houve aumento dos neurônios nitrérgicos entre G7 e G21 e nos neurônios colinérgicos entre G21 e G60. No jejuno somente houve aumento do número total de neurônios nitrérgicos entre G0 e G7. Também foi percebido um aumento significativo na área dos neurônios nitrérgicos a partir de G7 no jejuno e de G0 no colo, e dos neurônios colinérgicos entre G7 e G21 no jejuno e G0 e G21 no colo. A área ocupada pelos axônios aumentou entre os grupos G0 e G7, diminuiu entre G7 e G21 e aumentou de novo entre G21 e G60. Estes resultados demonstraram que os neurônios e os axônios sofrem mudanças morfológicas e químicas durante o desenvolvimento pós-natal do sistema nervoso entérico, provavelmente devido a fatores microambientais como os fatores de crescimento e de replicação, a alimentação e o próprio crescimento do intestino. É possível que a completa maturidade do intestino somente seja completada quando este finaliza o seu processo de crescimento. / The aim of this study was to quantify jejunum and colon myenteric neurons during postnatal development in Wistar rats using morphometry and to analyse the changes in the area occupied by neurons and axons using Geographic Information Sistem (GIS). Twenty female Wistar rats divided in groups according to the age in days (G0, G7, G21 e G60) were used. Whole mount preparations using cuprolinic blue (CB), histochemistry for acetyl-cholinesterase (AChE) and NADPH-diaphorase (NADPH-d) and immunohistochemistry for VIP and substance P were used for morphometric evaluation. Neuronal numerical density/area of serosal surface, total number of neurons for segment and mean neuronal area were estimated. Analyses of the area ocuppied by neurons and axons were performed using images of NADPH-d and AChE. This study showed a significant decrease in the neuronal numerical density/area in total and nitrergic neurons from G7 in jejunum and G0 in colon, and in cholinergic neurons from G0 and G7 in jejunum and G0 and G21 in colon. In colon, total number of neurons increased significantly in cuprolinic blue stain from G7, in NADPH-d between G7 and G21 and in AChE between G21 and G60. In jejunum, there was a significant increase in the same parameter between G0 and G7 in NADPH-d. There was also a significant increase in the mean area of nitrergic neurons from G7 in jejunum and from G0 in colon, and in cholinergic neurons between G7 and G21 in jejunum and between G0 and G21 in colon. The area occupied by axons increased between G0 and G7, between G7 and G21 decreased and increased again between G21 and G60. This results showed that neurons and axons suffer morphologic and chemical changes during postnatal development in the enteric nervous system, probably due to micro-environmental factors as growth and replication factors, nutrition and growing of the intestine. It is possible that complete maturity of the intestine is achieved when it finishes its growing process.