Handgrip strength

The basic function of the human hand is the manipulation and grasping of various objects in all daily activities, including work activities. This is greatly influenced by strength and manual dexterity. However age, gender and other contexts such as work or leisure activities could influence strength. Handgrip strength, a measure of maximum voluntary force of the hand, has proved to be reliable and valid as an objective parameter to evaluate the functional integrity of the hand as part of the musculoskeletal system. It correlates highly with strength in other muscular groups and is therefore considered as a good indicator of overall muscular strength and functional stress and could be used as a predictor of physical disability. Handgrip strength assessment is simple and reliable and used commonly by several investigators and health professionals, in different contexts (medical, nutritional, rehabilitation, professional settings, engineering, etc.) and with different purposes (research, diagnostic, assessment, etc.). In clinical and rehabilitation settings is of vital importance in the determination of effectiveness of several interventions and for monitoring evolution of diseases. Various ways (methods, techniques and equipments) of collecting information on grip strength have been reported. This chapter will review basic concepts on handgrip function, methodologies of assessment, contexts of application and correlates, such as physical activity, health or nutritional status. Several populations and reference values as also the relationships between handgrip and clinical status, aging, risk of disability and diseases, will be discussed

COLECISTECTOMIA: ASPECTOS TÉCNICOS E INDICAÇÕES PARA O TRATAMENTO DA LITÍASE BILIAR E DAS NEOPLASIAS

The surgical removal of the gallbladder has been practiced for more than a century and in the last 25 years has undergone fundamental changes in its technique, specially regarding access as well as the exploration of the biliary tree. The most frequent indications for cholecystectomy are gallbladder stones with its complications (acute cholecystitis, choledocolithiasis, cholangitis, acute biliary pancreatitis) and neoplasia of the gallbladder. Initially, cholecystectomies for the treatment of gallbladder stones, were performed through laparotomies. By the end of the 20th century, these surgeries were being performed through progressively smaller incisions, such as minilaparotomy and was soon followed by videolaparoscopy, which is now considered the gold standard. More recently, this procedure is being carried out, although still in the experimental stage, through a transgastric or transvaginal access. The benefits of the videolaparoscopic access is incontestable, but its use requires caution and training in order to minimize the incidence of traumatic lesions of the biliary tree or other structures.A remoção cirúrgica da vesícula biliar é uma operação realizada há mais de um século e nos últimos 25 anos foi objeto de inovação nos seus fundamentos técnicos, especialmente, em relação ao acesso e a exploração da via biliar principal. As indicações mais freqüentes de colecistectomia são a litíase biliar e suas complicações (colecistite aguda, coledocolitíase, colangite , pancreatite aguda biliar) e o câncer da vesícula biliar. Inicialmente, as colecistectomias para tratamento da litíase biliar eram realizadas por meio de laparotomia. No fim do século vinte, a colecistectomia passou a ser feita por meio de acessos menores como a minilaparotomia e em seguida pela videolaparoscopia, que é o acesso considerado como padrão na atualidade. Mais recentemente, a colecistectomia tem sido realizada, em caráter experimental ou excepcional, por meio do acesso transgástrico e transvaginal. Os benefícios do acesso videolaparoscópico são incontestáveis, mas o emprego desse acesso requer cautela e capacitação para minimizar a incidência de lesões traumáticas da via biliar e de outras estruturas

Gastrostomia e jejunostomia: aspectos da evolução técnica e da ampliação das indicações

O acesso à luz do estômago e do jejuno proximal por meio de gastrostomia e jejunostomia, respectivamente, de forma temporária ou definitiva, está indicado diante da necessidade prolongada de descompressão digestiva ou de suporte alimentar. O emprego desses procedimentos expandiu-se nos últimos25 anos com a introdução da gastrostomia endoscópica, especialmente em pacientes com afecçõesneurológicas de evolução progressiva e neoplasias avançadas. Este artigo aborda aspectos conceituaisda gastrostomia e jejunostomia, as principais indicações, as vias de acesso preferenciais em diferentes cenários clínicos e as modalidades técnicas frequentemente empregadas. O manejo dessasestomias, os resultados e as potenciais complicações também são enfatizados. Finalmente, os fundamentos éticos e legais da ampliação da indicação da gastrostomia e da jejunostomia como procedimentos paliativos são discutidos.A temporary or permanent access to the stomach or jejunum, through a gastrostomy or jejunostomy, isindicated whenever nutritional support or prolonged decompression of the upper alimentary tract isneeded.  With the introduction of endoscopic gastrostomy, the utilization of these procedures has increased in the last 25 years, specially in patients with progressive neurologic diseases and in those withadvanced cancer.  This article deals with the conceptual aspects of gastrostomies and jejunostomies, itsprimary indications, the preferential means of access in different clinical scenarios as well as the technical modalities most frequently used.  The management of the stomas, the results and potential complications are also highlighted. Finally, the ethical and legal implications of greater utilization of theseprocedures in a palliative setting are also discussed

Silent peripheral neuropathy determined by high-resolution ultrasound among contacts of patients with Hansen's disease

IntroductionHansen's disease (HD) primarily infects peripheral nerves, with patients without HD being free of peripheral nerve damage. Household contacts (HHCs) of patients with HD are at a 5–10 times higher risk of HD than the general population. Neural thickening is one of the three cardinal signs that define a case of HD according to WHO guidelines, exclusively considering palpation examination that is subjective and may not detect the condition in the earliest cases even when performed by well-trained professionals. High-resolution ultrasound (HRUS) can evaluate most peripheral nerves, a validated technique with good reproducibility allowing detailed and accurate examination.ObjectiveThis study aimed to use the peripheral nerve HRUS test according to the HD protocol as a diagnostic method for neuropathy comparing HHCs with healthy volunteers (HVs) and patients with HD.MethodsIn municipalities from 14 different areas of Brazil we selected at random 83 HHC of MB-patients to be submitted to peripheral nerve ultrasound and compared to 49 HVs and 176 HD-patients.ResultsHousehold contacts assessed by HRUS showed higher median and mean absolute peripheral nerve cross-sectional area (CSA) values and greater asymmetries (ΔCSA) compared to HVs at the same points. Median and mean absolute peripheral nerve CSA values were higher in patients with HD compared to HCCs at almost all points, while ΔCSA values were equal at all points. Mean ± SD focality (ΔTpT) values for HHCs and patients with HD, respectively, were 2.7 ± 2.2/2.6 ± 2.2 for the median nerve, 2.9 ± 2.7/3.3 ± 2.9 for the common fibular nerve (p > 0.05), and 1.3 ± 1.3/2.2 ± 3.9 for the ulnar nerve (p < 0.0001).DiscussionConsidering HRUS findings for HHCs, asymmetric multiple mononeuropathy signs (thickening or asymmetry) in at least 20% of the nerves evaluated could already indicates evidence of HD neuropathy. Thus, if more nerve points are assessed in HHCs (14 instead of 10), the contacts become more like patients with HD according to nerve thickening determined by HRUS, which should be a cutting-edge tool for an early diagnosis of leprosy cases

Development of a lethal model of peritonitis for assessment of laparoscopic and laparotomic treatments in rats Desenvolvimento de um modelo letal de peritonite para avaliação do tratamento por laparoscopia e laparotomia em ratos

PURPOSE: Development of a lethal model of peritonitis to assess the results of treating that peritonitis using videolaparoscopy and laparotomy. METHODS: We developed a model of peritonitis in rats using cecal ligation (CLP) against a 2-mm diameter rigid mold and puncture. Two experiments were performed: determination of seven-day lethality; and analysis of white cell counts, blood cultures and cytokines (Interleukin-1 beta, Tumor Necrosis Factor-alpha and IL-6). The animals were divided into four groups: I - Sham surgery; II - CLP; III - CLP + Videolaparoscopy; and IV- CLP + Laparotomy . RESULTS: Seven-day lethality was 0% in group I, 80% in the group II (p<0.05), 60% in group III , and 20 % in group IV. There was a significant reduction in leukocyte counts and higher levels of serum IL-1 beta, TNF-alpha and IL-6 in the group II compared to controls. The percentages of positive blood cultures were higher after videolaparoscopic compared to laparotomic treatment. CONCLUSION: The experimental model provoked a lethal form of peritonitis and that videolaparoscopic treatment had more bacteraemia than laparotomy.<br>OBJETIVO: Desenvolvimento de um modelo letal de peritonite para avaliar o tratamento desta peritonite por videolaparoscopia e laparotomia. MÉTODOS: Foi desenvolvido um modelo de peritonite em ratos utilizando ligadura do ceco (CLP) contra um molde rígido de 2mm de diâmetro, seguido de punção do órgão. Dois experimentos foram realizados: determinação da letalidade de 7 dias; e análise da leucometria, hemocultura e dos valores de citocinas (Interleucina-1 beta, TNF-alfa e IL-6). Os animais foram divididos em quatro grupos: I - Cirurgia simulada; II - CLP; III - CLP + Videolaparoscopia; e IV- CLP + Laparotomia . RESULTADOS: A letalidade de sete dias foi de 0% no grupo I, 80% no grupo II (p<0.05), 60% no grupo III , e 20 % no grupo IV. Houve uma redução significativa na contagem de leucócitos e maiores níveis de citocinas séricas no grupo II quando comparado com o grupo controle. A porcentagem de hemoculturas positivas foi maior após videolaparoscopia quando comparado com o tratamento por laparotomia. CONCLUSÃO: O modelo experimental provocou uma forma de peritonite letal e que o tratamento por videolaparoscopia apresenta maiores taxas de bacteremia que o tratamento por laparotomia

Nonalcoholic fatty liver disease and obesity Doença gordurosa não alcóolica do fígado e obesidade

PURPOSE: The aim of this review is to update concepts of the nonalcoholic fatty liver disease (NAFLD) and to establish a relationship between this condition and obesity. METHODS: By means of a comprehensive literature review where special attention was devoted to articles published in the last 5 years, NAFLD is discussed in view of new concepts, diagnosis, staging, and treatment. RESULTS: NAFLD is emerging as one of the main causes of chronic liver disease and it is believed to be the hepatic component of the metabolic syndrome, whose central features include obesity, hyperinsulinemia, peripheral insulin resistance, diabetes, dyslipidemia, and hypertension. The surgical treatment of morbid obesity is one of the options available for the treatment of NAFLD. CONCLUSION: Nonalcoholic fatty liver disease is strongly related with obesity.<br>OBJETIVO: O objetivo deste artigo foi atualizar conceitos com relação à doença gordurosa não alcoólica do fígado (DGNAF) e a sua intrínseca relação com a obesidade. MÉTODOS: Por meio de revisão bibliográfica, com atenção especial às publicações dos últimos 5 anos, o assunto foi abordado com relação à conceituação, ao diagnóstico, estadiamento e tratamento. RESULTADO: A DGNAF está emergindo como uma das maiores causas de doença crônica do fígado e representa o componente hepático da síndrome metabólica, caracterizada por obesidade, hiperinsulinemia, resistência periférica à insulina, diabete, hipertrigliceridemia e hipertensão. O tratamento cirúrgico da obesidade mórbida faz parte do arsenal terapêutico da DGNAF. CONCLUSÃO: O tema foi amplamente discutido, baseado em estudos recentes