No abstract

BACKGROUND:Patellofemoral Pain Syndrome is one of the most common knee disorders among physically active young women. Despite its high incidence, the multifactorial etiology of this disorder is not fully understood.OBJECTIVES:To investigate the influence of Patellofemoral Pain Syndrome on plantar pressure distribution during the foot rollover process (i.e., the initial heel contact, midstance and propulsion phases) of the gait.MATERIALS AND METHODS:Fifty-seven young adults, including 22 subjects with Patellofemoral Pain Syndrome (30 ± 7 years, 165 ± 9 cm, 63 ± 12 kg) and 35 control subjects (29 ± 7 years, 164 ± 8 cm, 60 ± 11 kg), volunteered for the study. The contact area and peak pressure were evaluated using the Pedar-X system (Novel, Germany) synchronized with ankle sagittal kinematics.RESULTS:Subjects with Patellofemoral Pain Syndrome showed a larger contact area over the medial (p = 0.004) and central (p = 0.002) rearfoot at the initial contact phase and a lower peak pressure over the medial forefoot (p = 0.033) during propulsion when compared with control subjects.CONCLUSIONS:Patellofemoral Pain Syndrome is related to a foot rollover pattern that is medially directed at the rearfoot during initial heel contact and laterally directed at the forefoot during propulsion. These detected alterations in the foot rollover process during gait may be used to develop clinical interventions using insoles, taping and therapeutic exercise to rehabilitate this dysfunction.

Recebido em 31/10/07 Aprovado em 11/04/08Resumo -O desenvolvimento tecnológico no ambiente de trabalho gerou um aumento no tempo em que os indivíduos permanecem sentados enquanto trabalham em escritórios. Isto pode estar influenciando negativamente capacidades físicas inatas como a flexibilidade da cadeia posterior do corpo, porém poucos são os estudos que avaliaram a influência do trabalho nesta capacidade física. Esta avaliação pode contribuir para intervenção precoce e paralela à atividade ocupacional, prevenindo disfunções musculoesqueléticas. O objetivo foi verificar se a atividade profissional determina alguma modificação na flexibilidade global da cadeia posterior na postura de flexão do tronco e analisar os segmentos corporais contribuidores desta modificação. Participaram do estudo 24 mulheres saudáveis e sedentárias, entre 18 e 55 anos, que trabalhavam em manutenção (n=13) e em escritório (n=11). Foram avaliados o teste do terceiro dedo ao solo (fita métrica) e os ângulos articulares tíbio-társico, do joelho, do quadril, da lombar e a técnica de Chaffin Modificada por meio da fotogrametria (software SAPo) na postura de flexão do tronco. Os grupos foram comparados por meio de teste t (α=5%). Mulheres que trabalham em escritório mostraram maiores distâncias do terceiro dedo ao solo (p=0,0518) e técnica de Chaffin Modificada significativamente menor . (p=0,0134), enquanto os ângulos tíbio-tarsico e do quadril mostraram valores marginalmente maiores nestas mulheres (p=0,0609 e p= 0,0713, respectivamente). Mulheres que trabalham predominantemente na posição sentada apresentam menor flexibilidade global da cadeia posterior quando comparadas com as que realizam um trabalho que exige flexão cíclica do tronco. Sugere-se que os ângulos tíbio-tarsico e quadril, em conjunto, são os segmentos corporais que contribuem para esta menor flexibilidade. Palavras-chave: Flexibilidade; Postura; Amplitude de movimento articular. Abstract -

A 65-year-old man was admitted to our hospital with a 6-month history of increasing abdominal size. His medical history was unremarkable. On physical examination, a mass was felt in the right abdomen. Laboratory tests were within normal range. In particular, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were 21 and 22 U/dL, respectively (normal range Յ40 U/dL). Computed tomography scan showed a 16-cm peritoneal mass without evidence of hepatic involvement. A gastrointestinal stromal tumor (GIST) was diagnosed and imatinib (IM) therapy (400 mg/d) was started. One month later, abdominal computed tomography scan showed initial shrinkage of this mass, but an asymptomatic progressive increase of AST and ALT values was observed. IM was withdrawn on the hypothesis of a rare toxicity due to IM. Nevertheless, AST and ALT went up to 418 and 1056 U/dL, respectively ( Fig. 1). All other liver function tests were within normal range, and no viral infection could be detected. Alcohol and other drug abuse were excluded. Antinuclear antibodies and M2 fraction of antimitochondrial antibodies were positive. A liver biopsy showed no tumoral cells but interface hepatitis with piecemeal necrosis (Fig. 2). This picture was consistent with an autoimmune hepatitis (AH). 1 Ursodeoxycholic acid (1200 mg/d) and prednisone (1 mg/kg/d) were begun. Six weeks later, imatinib was given at the dose of 400 mg/d. The aminotransferase serum levels decreased progressively (Fig. 1) and prednisone, as well as ursodeoxycholic acid, was suspended after 6 months. One month later, a liver biopsy showed a complete resolution of the inflammatory disease (Fig. 3). IM therapy was continued, and the patient was well at his last follow-up visit.Hepatotoxicity (mild transaminitis) is observed in 10% of patients treated with imatinib, and a grade 3 or 4 elevation in liver function tests affects fewer patients. 2 Imatinib has been occasionally reported to cause hepatotoxicity 3 with a common histologic signature: a centrolobular hepatic necrosis with lymphoplasmacytic infiltration and interface hepatitis. In one case, antinuclear antibodies were elevated while autoantibodies were either normal or not evaluated in other reports. None of the largest published series examine the 3% to 5% reported G3-4 hepatotoxicity, 2 and this is the first case, to our knowledge, of AH described during imatinib therapy in GIST. The association of GIST, IM, and AH may have been coincidental, but the chronological sequence raises the suspicion of a causal relationship. Less clear is the pathogenesis of this phenomenon. A first hypothesis is that IM itself could have been the triggering event. In a relatively "young" drug, rare side effects become evident in the long run. However, we suggest this is an unlikely mechanism. Indeed, autoimmune drug (eg, phenytoin) side effects require drug withdrawal, and readministration From the

The aim of this study was to investigate the influence of image resolution manipulation on the photogrammetric measurement of the rearfoot static angle. The study design was that of a reliability study. We evaluated 19 healthy young adults (11 females and 8 males). The photographs were taken at 1536 pixels in the greatest dimension, resized into four different resolutions (1200, 768, 600, 384 pixels) and analyzed by three equally trained examiners on a 96-pixels per inch (ppi) screen. An experienced physiotherapist marked the anatomic landmarks of rearfoot static angles on two occasions within a 1-week interval. Three different examiners had marked angles on digital pictures. The systematic error and the smallest detectable difference were calculated from the angle values between the image resolutions and times of evaluation. Different resolutions were compared by analysis of variance. Inter-and intra-examiner reliability was calculated by intra-class correlation coefficients (ICC). The rearfoot static angles obtained by the examiners in each resolution were not different (P > 0.05); however, the higher the image resolution the better the inter-examiner reliability. The intra-examiner reliability (within a 1-week interval) was considered to be unacceptable for all image resolutions (ICC range: 0.08-0.52). The whole body image of an adult with a minimum size of 768 pixels analyzed on a 96-ppi screen can provide very good inter-examiner reliability for photogrammetric measurements of rearfoot static angles (ICC range: 0.85-0.92), although the intra-examiner reliability within each resolution was not acceptable. Therefore, this method is not a proper tool for follow-up evaluations of patients within a therapeutic protocol.