The Consensus on restless legs syndrome is an effort of neurologists from several Brazilian state... more The Consensus on restless legs syndrome is an effort of neurologists from several Brazilian states, which tirelessly reviewed the literature of recent years in search of evidence, both in regard to diagnosis and treatment, according to the Oxford Centre for Evidence-based Medicine.O Consenso em síndrome das pernas inquietas contou com a participação de neurologistas de vários estados brasileiros, os quais incansavelmente revisaram a literatura dos últimos anos em busca de evidências, tanto no que se refere ao diagnóstico como ao tratamento, de acordo com a Classificação do Centro de Oxford para Medicina Baseada em Evidências
Não é de admirar que uma doença como o hiperparatireoidismo que pode causar uma alteração estrutu... more Não é de admirar que uma doença como o hiperparatireoidismo que pode causar uma alteração estrutural no esqueleto, rins ou tubo digestivo, tivesse algum efeito no sistema nervoso. Mas é surpreendente que a maioria dos pacientes com hypercalcemia internados para investigação de hiperparatireoidismo, que é a causa mais freqüente de elevação do cálcio sérico, mostrassem uma ou mais manifestações neurológicas. MATERIAL Ε MÉTODOS O estudo foi realizado em colaboração com a Divisão de Neurologia do Departamento de Medicina Interna, Divisão de Cirurgia e Arquivo Médico e de Estatística do Centro Médico da Duke University em Durham durante o ano de 1978. Trata-se de um estudo retrospectivo que engloba 120 pacientes internados para investigação de hiperparatireoidismo durante o período compreendido entre 1962 e 1977. Destes 120 pacientes, 6 foram admitidos duas vezes pelo mesmo problema. Quanto ao sexo, 84 pacientes eram do sexo feminino e 36 do sexo masculino. A idade variou entre 3 e 81 anos. Em todos os 120 pacientes estudados o exame neurológico foi realizado pré-operatoriamente. Infelizmente essa avaliação no período pós-operatório não existe para termos de comparação. Levamos em consideração, em todos os pacientes, condições associadas, medicamentos em uso, dosagem de sódio, potássio, nitrogênio ureico, creatinine, fosfatase alcalina, SGOT, LDH, cálcio e fósforo. Dos 120 pacientes, 92 foram submetidos à paratireoidectomia e biópsia. Em 24 foi realizada dosagem de paratõrmonio pré-operatória.
Este artigo contém as conclusões de reunião de 17-18 de novembro de 2006 do Grupo Brasileiro de E... more Este artigo contém as conclusões de reunião de 17-18 de novembro de 2006 do Grupo Brasileiro de Estudo em Síndrome das Pernas Inquietas (GBE-SPI) sobre diagnóstico e tratamento de SPI. Reiterou-se que se trata de condição de diagnóstico exclusivamente clínico, caracterizada por sensação anormal localizada, sobretudo, mas não exclusivamente, em membros inferiores, com piora noturna e alívio por movimentação da parte envolvida. Agentes terapêuticos com eficácia comprovada por estudos classe I são agonistas dopaminérgicos, levodopa e gabapentina enquanto que ácido valpróico de liberação lenta, clonazepam, oxicodona e reposição de ferro têm eficácia sugerida por estudos classe II. As recomendações do GBE-SPI para manejo de SPI primária são medidas de higiene do sono, suspensão de agentes agravantes de SPI, tratamento de comorbidades e agentes farmacológicos. Para estes as drogas de primeira escolha são agentes dopaminérgicos; segunda escolha são gabapentina ou oxicodona; e terceira esco...
In this paper, we present and discuss the methodology to monitor average residual stresses in age... more In this paper, we present and discuss the methodology to monitor average residual stresses in aged high temperature unidirectional and woven graphite fiber/PMR-15 composites. The aging experiments were performed at 315 • C for 1170 h in nitrogen and 1064 h in air, respectively. The proposed methodology was based on X-ray diffraction (XRD) strain measurements in embedded crystalline metallic inclusions. The aging experiments performed in nitrogen showed an increasing trend in the measured residual stresses from the embedded inclusions with aging time. In contrast, the aging experiments performed in air showed an increasing trend up to ∼200 h and then dropped by ∼40% for both unidirectional and woven composites. To extract the average stresses in the composite matrix from the average stresses in embedded inclusions as determined using XRD, the well-established Eshelby/Mori-Tanaka method was used. In addition, to address the effect of inclusion interactions, we also computed the average stresses in the embedded inclusions by taking into account inclusion interactions within the framework of the Eshelby/Mori-Tanaka method. It was shown that the interactions between the inclusions did not significantly disturb the average stresses in the inclusions, thereby validating the Eshelby/Mori-Tanaka method used in our analysis. Finally, we show that for an aging process that does not cause any damage to a composite matrix, a relatively simple computation based on the visco-elastic Eshelby/Mori-Tanaka method is sufficient to determine the average stress field in a composite matrix as compared with the predictions based on classical lamination plate theory (CLPT). However, if significant matrix degradation occurs, the current micromechanical modeling approach would likely produce erroneous results.
ABSTRACT A testing methodology for the determination of residual thermal stresses in the polymer-... more ABSTRACT A testing methodology for the determination of residual thermal stresses in the polymer-matrix of unidirectional polymer-matrix composites has been proposed in Ref. [1] [Benedikt B, Kumosa M, Predecki PK, Kumosa L, Castelli MG, Sutter JK. An analysis of residual thermal stresses in a unidirectional graphite/PMR-15 composite based on the X-ray diffraction measurements. Composites Science and Technology (in press)]. The methodology is based X-ray diffraction (XRD) measurements of residual strains in embedded metallic particles. The residual stresses in the polymer matrix can be extracted from the X-ray strains in the particles using the visco-elastic Eshelby method for multiple inclusions. The purpose of this work has been to show that the newly developed experimental/analytical methodology can also be applied to composites subjected to external loads, in this case: spherical aluminum particles embedded in a unidirectional graphite/PMR-15 composite subjected to four-point bending loads. The total stresses and strains in the aluminum particles caused by residual thermal stresses in the composite and the applied stresses generated by four-point bending have been determined by XRD measurements under low bending displacements. Subsequently, the total strains and stresses in the aluminum particles have been numerically predicted by applying elastic and visco-elastic laminate theories and the Eshelby method. It has been shown in this research that not only the residual thermal strains and stresses in the aluminum particles and the matrix can be determined by using the proposed technique but also the effect of external loads on the stresses and strains in the particles can be monitored. This research has provided another verification of the newly proposed methodology presented in Ref. [1].
The Brazilian Sleep Association brought together specialists in sleep medicine, in order to devel... more The Brazilian Sleep Association brought together specialists in sleep medicine, in order to develop new guidelines on the diagnosis and treatment of insomnias. The following subjects were discussed: concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children. Four levels of evidence were envisaged: standard, recommended, optional and not recommended. For diagnosing of insomnia, psychosocial and polysomnographic investigation were recommended. For non-pharmacological treatment, cognitive behavioral treatment was considered to be standard, while for pharmacological treatment, zolpidem was indicated as the standard drug because of its hypnotic profile, while zopiclone, trazodone and doxepin were recommended. Key words: insomnia, diagnosis of insomnia, treatment of insomnia, cognitive behavioral therapy. Novas diretrizes no diagnóstico e tratamento das insônias resumo A Associação Brasileira de Sono reuniu especialistas em medicina do sono com o objetivo de desenvolver novas diretrizes no diagnóstico e tratamento das insônias. Nós consideramos quatro níveis de evidência: padrão, recomendado, opcional e não recomendado. Os tópicos abordados foram: conceito, avaliação clínica e psicossocial, indicação da polissonografia, tratamento farmacológico, terapia comportamental cognitiva, comorbidades e insônia na infância. Para o diagnóstico da insônia, foi recomendada uma avaliação psicossocial e a realização da polissonografia, enquanto que no que se refere ao tratamento, foi estabelecido como padrão a indicação da terapia comportamental cognitiva, e, quanto ao tratamento farmacológico, foi indicado o uso do zolpidem como hipnótico padrão, e sendo recomendado o zopiclone, a trazodona e a doxepina. Palavras-chave: insônia, diagnóstico da insônia, tratamento da insônia, terapia comportamental cognitiva.
É feito um estudo retrospectivo de 120 pacientes internados para investigação de hiperparatireoid... more É feito um estudo retrospectivo de 120 pacientes internados para investigação de hiperparatireoidismo. Tendo em vista as manifestações neurológicas do hiperparatireoidismo primário realizamos também um confronto com os achados de outros autores.
The Brazilian Sleep Association brought together specialists in sleep medicine, in order to devel... more The Brazilian Sleep Association brought together specialists in sleep medicine, in order to develop new guidelines on the diagnosis and treatment of insomnias. The following subjects were discussed: concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children. Four levels of evidence were envisaged: standard, recommended, optional and not recommended. For diagnosing of insomnia, psychosocial and polysomnographic investigation were recommended. For non-pharmacological treatment, cognitive behavioral treatment was considered to be standard, while for pharmacological treatment, zolpidem was indicated as the standard drug because of its hypnotic profile, while zopiclone, trazodone and doxepin were recommended.
The Brazilian Sleep Association brought together specialists in sleep medicine, in order to devel... more The Brazilian Sleep Association brought together specialists in sleep medicine, in order to develop new guidelines on the diagnosis and treatment of insomnias. The following subjects were discussed: concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children. Four levels of evidence were envisaged: standard, recommended, optional and not recommended. For diagnosing of insomnia, psychosocial and polysomnographic investigation were recommended. For non-pharmacological treatment, cognitive behavioral treatment was considered to be standard, while for pharmacological treatment, zolpidem was indicated as the standard drug because of its hypnotic profile, while zopiclone, trazodone and doxepin were recommended. Key words: insomnia, diagnosis of insomnia, treatment of insomnia, cognitive behavioral therapy. Novas diretrizes no diagnóstico e tratamento das insônias r...
This manuscript contains the conclusion of the consensus meeting on the diagnosis of narcolepsy b... more This manuscript contains the conclusion of the consensus meeting on the diagnosis of narcolepsy based on the review of Medline publications between 1980-2010. Narcolepsy is a chronic disorder with age at onset between the first and second decade of life. Essential narcolepsy symptoms are cataplexy and excessive sleepiness. Cataplexy is defined as sudden, recurrent and reversible attacks of muscle weakness triggered by emotions. Accessory narcolepsy symptoms are hypnagogic hallucinations, sleep paralysis and nocturnal fragmented sleep. The clinical diagnosis according to the International Classification of Sleep Disorders is the presence of excessive sleepiness and cataplexy. A full in-lab polysomnography followed by a multiple sleep latency test is recommended for the confirmation of the diagnosis and co-morbidities. The presence of two sleep-onset REM period naps in the multiple sleep latency test is diagnostic for cataplexy-free narcolepsy. A positive HLA-DQB1*0602 with lower than...
Objective: to determine the value of dopamine transporter (DAT) neuroimaging radiotracer in a gro... more Objective: to determine the value of dopamine transporter (DAT) neuroimaging radiotracer in a group of idiopathic rapid eye movement sleep behavior disorder (iRBD) patients regarding the development of a synucleinopathy. Methods: 6 retrospectively selected patients with clinical and polysomnographic diagnosis of iRBD, on treatment or not, were submitted to a single-photon emission computerized tomography (SPECT) with TRODAT. Results: Five from six patients have an abnormal test showing reduction in DAT density measured by the linkage potential on SPECT. Conclusions: TRODAT crosses the blood brain barrier, has a high affinity for DAT and is capture by SPECT. The decreased uptake of DAT tracers means a reduction in dopaminergic activity which suggest the possibility of Parkinson Disease. We have tried to reinforce iRBD as a marker of neurodegenerative disease and suggest SPECT with TRODAT as an easy method in our country to follow longitudinally these patients.
The Consensus on restless legs syndrome is an effort of neurologists from several Brazilian state... more The Consensus on restless legs syndrome is an effort of neurologists from several Brazilian states, which tirelessly reviewed the literature of recent years in search of evidence, both in regard to diagnosis and treatment, according to the Oxford Centre for Evidence-based Medicine.O Consenso em síndrome das pernas inquietas contou com a participação de neurologistas de vários estados brasileiros, os quais incansavelmente revisaram a literatura dos últimos anos em busca de evidências, tanto no que se refere ao diagnóstico como ao tratamento, de acordo com a Classificação do Centro de Oxford para Medicina Baseada em Evidências
Não é de admirar que uma doença como o hiperparatireoidismo que pode causar uma alteração estrutu... more Não é de admirar que uma doença como o hiperparatireoidismo que pode causar uma alteração estrutural no esqueleto, rins ou tubo digestivo, tivesse algum efeito no sistema nervoso. Mas é surpreendente que a maioria dos pacientes com hypercalcemia internados para investigação de hiperparatireoidismo, que é a causa mais freqüente de elevação do cálcio sérico, mostrassem uma ou mais manifestações neurológicas. MATERIAL Ε MÉTODOS O estudo foi realizado em colaboração com a Divisão de Neurologia do Departamento de Medicina Interna, Divisão de Cirurgia e Arquivo Médico e de Estatística do Centro Médico da Duke University em Durham durante o ano de 1978. Trata-se de um estudo retrospectivo que engloba 120 pacientes internados para investigação de hiperparatireoidismo durante o período compreendido entre 1962 e 1977. Destes 120 pacientes, 6 foram admitidos duas vezes pelo mesmo problema. Quanto ao sexo, 84 pacientes eram do sexo feminino e 36 do sexo masculino. A idade variou entre 3 e 81 anos. Em todos os 120 pacientes estudados o exame neurológico foi realizado pré-operatoriamente. Infelizmente essa avaliação no período pós-operatório não existe para termos de comparação. Levamos em consideração, em todos os pacientes, condições associadas, medicamentos em uso, dosagem de sódio, potássio, nitrogênio ureico, creatinine, fosfatase alcalina, SGOT, LDH, cálcio e fósforo. Dos 120 pacientes, 92 foram submetidos à paratireoidectomia e biópsia. Em 24 foi realizada dosagem de paratõrmonio pré-operatória.
Este artigo contém as conclusões de reunião de 17-18 de novembro de 2006 do Grupo Brasileiro de E... more Este artigo contém as conclusões de reunião de 17-18 de novembro de 2006 do Grupo Brasileiro de Estudo em Síndrome das Pernas Inquietas (GBE-SPI) sobre diagnóstico e tratamento de SPI. Reiterou-se que se trata de condição de diagnóstico exclusivamente clínico, caracterizada por sensação anormal localizada, sobretudo, mas não exclusivamente, em membros inferiores, com piora noturna e alívio por movimentação da parte envolvida. Agentes terapêuticos com eficácia comprovada por estudos classe I são agonistas dopaminérgicos, levodopa e gabapentina enquanto que ácido valpróico de liberação lenta, clonazepam, oxicodona e reposição de ferro têm eficácia sugerida por estudos classe II. As recomendações do GBE-SPI para manejo de SPI primária são medidas de higiene do sono, suspensão de agentes agravantes de SPI, tratamento de comorbidades e agentes farmacológicos. Para estes as drogas de primeira escolha são agentes dopaminérgicos; segunda escolha são gabapentina ou oxicodona; e terceira esco...
In this paper, we present and discuss the methodology to monitor average residual stresses in age... more In this paper, we present and discuss the methodology to monitor average residual stresses in aged high temperature unidirectional and woven graphite fiber/PMR-15 composites. The aging experiments were performed at 315 • C for 1170 h in nitrogen and 1064 h in air, respectively. The proposed methodology was based on X-ray diffraction (XRD) strain measurements in embedded crystalline metallic inclusions. The aging experiments performed in nitrogen showed an increasing trend in the measured residual stresses from the embedded inclusions with aging time. In contrast, the aging experiments performed in air showed an increasing trend up to ∼200 h and then dropped by ∼40% for both unidirectional and woven composites. To extract the average stresses in the composite matrix from the average stresses in embedded inclusions as determined using XRD, the well-established Eshelby/Mori-Tanaka method was used. In addition, to address the effect of inclusion interactions, we also computed the average stresses in the embedded inclusions by taking into account inclusion interactions within the framework of the Eshelby/Mori-Tanaka method. It was shown that the interactions between the inclusions did not significantly disturb the average stresses in the inclusions, thereby validating the Eshelby/Mori-Tanaka method used in our analysis. Finally, we show that for an aging process that does not cause any damage to a composite matrix, a relatively simple computation based on the visco-elastic Eshelby/Mori-Tanaka method is sufficient to determine the average stress field in a composite matrix as compared with the predictions based on classical lamination plate theory (CLPT). However, if significant matrix degradation occurs, the current micromechanical modeling approach would likely produce erroneous results.
ABSTRACT A testing methodology for the determination of residual thermal stresses in the polymer-... more ABSTRACT A testing methodology for the determination of residual thermal stresses in the polymer-matrix of unidirectional polymer-matrix composites has been proposed in Ref. [1] [Benedikt B, Kumosa M, Predecki PK, Kumosa L, Castelli MG, Sutter JK. An analysis of residual thermal stresses in a unidirectional graphite/PMR-15 composite based on the X-ray diffraction measurements. Composites Science and Technology (in press)]. The methodology is based X-ray diffraction (XRD) measurements of residual strains in embedded metallic particles. The residual stresses in the polymer matrix can be extracted from the X-ray strains in the particles using the visco-elastic Eshelby method for multiple inclusions. The purpose of this work has been to show that the newly developed experimental/analytical methodology can also be applied to composites subjected to external loads, in this case: spherical aluminum particles embedded in a unidirectional graphite/PMR-15 composite subjected to four-point bending loads. The total stresses and strains in the aluminum particles caused by residual thermal stresses in the composite and the applied stresses generated by four-point bending have been determined by XRD measurements under low bending displacements. Subsequently, the total strains and stresses in the aluminum particles have been numerically predicted by applying elastic and visco-elastic laminate theories and the Eshelby method. It has been shown in this research that not only the residual thermal strains and stresses in the aluminum particles and the matrix can be determined by using the proposed technique but also the effect of external loads on the stresses and strains in the particles can be monitored. This research has provided another verification of the newly proposed methodology presented in Ref. [1].
The Brazilian Sleep Association brought together specialists in sleep medicine, in order to devel... more The Brazilian Sleep Association brought together specialists in sleep medicine, in order to develop new guidelines on the diagnosis and treatment of insomnias. The following subjects were discussed: concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children. Four levels of evidence were envisaged: standard, recommended, optional and not recommended. For diagnosing of insomnia, psychosocial and polysomnographic investigation were recommended. For non-pharmacological treatment, cognitive behavioral treatment was considered to be standard, while for pharmacological treatment, zolpidem was indicated as the standard drug because of its hypnotic profile, while zopiclone, trazodone and doxepin were recommended. Key words: insomnia, diagnosis of insomnia, treatment of insomnia, cognitive behavioral therapy. Novas diretrizes no diagnóstico e tratamento das insônias resumo A Associação Brasileira de Sono reuniu especialistas em medicina do sono com o objetivo de desenvolver novas diretrizes no diagnóstico e tratamento das insônias. Nós consideramos quatro níveis de evidência: padrão, recomendado, opcional e não recomendado. Os tópicos abordados foram: conceito, avaliação clínica e psicossocial, indicação da polissonografia, tratamento farmacológico, terapia comportamental cognitiva, comorbidades e insônia na infância. Para o diagnóstico da insônia, foi recomendada uma avaliação psicossocial e a realização da polissonografia, enquanto que no que se refere ao tratamento, foi estabelecido como padrão a indicação da terapia comportamental cognitiva, e, quanto ao tratamento farmacológico, foi indicado o uso do zolpidem como hipnótico padrão, e sendo recomendado o zopiclone, a trazodona e a doxepina. Palavras-chave: insônia, diagnóstico da insônia, tratamento da insônia, terapia comportamental cognitiva.
É feito um estudo retrospectivo de 120 pacientes internados para investigação de hiperparatireoid... more É feito um estudo retrospectivo de 120 pacientes internados para investigação de hiperparatireoidismo. Tendo em vista as manifestações neurológicas do hiperparatireoidismo primário realizamos também um confronto com os achados de outros autores.
The Brazilian Sleep Association brought together specialists in sleep medicine, in order to devel... more The Brazilian Sleep Association brought together specialists in sleep medicine, in order to develop new guidelines on the diagnosis and treatment of insomnias. The following subjects were discussed: concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children. Four levels of evidence were envisaged: standard, recommended, optional and not recommended. For diagnosing of insomnia, psychosocial and polysomnographic investigation were recommended. For non-pharmacological treatment, cognitive behavioral treatment was considered to be standard, while for pharmacological treatment, zolpidem was indicated as the standard drug because of its hypnotic profile, while zopiclone, trazodone and doxepin were recommended.
The Brazilian Sleep Association brought together specialists in sleep medicine, in order to devel... more The Brazilian Sleep Association brought together specialists in sleep medicine, in order to develop new guidelines on the diagnosis and treatment of insomnias. The following subjects were discussed: concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children. Four levels of evidence were envisaged: standard, recommended, optional and not recommended. For diagnosing of insomnia, psychosocial and polysomnographic investigation were recommended. For non-pharmacological treatment, cognitive behavioral treatment was considered to be standard, while for pharmacological treatment, zolpidem was indicated as the standard drug because of its hypnotic profile, while zopiclone, trazodone and doxepin were recommended. Key words: insomnia, diagnosis of insomnia, treatment of insomnia, cognitive behavioral therapy. Novas diretrizes no diagnóstico e tratamento das insônias r...
This manuscript contains the conclusion of the consensus meeting on the diagnosis of narcolepsy b... more This manuscript contains the conclusion of the consensus meeting on the diagnosis of narcolepsy based on the review of Medline publications between 1980-2010. Narcolepsy is a chronic disorder with age at onset between the first and second decade of life. Essential narcolepsy symptoms are cataplexy and excessive sleepiness. Cataplexy is defined as sudden, recurrent and reversible attacks of muscle weakness triggered by emotions. Accessory narcolepsy symptoms are hypnagogic hallucinations, sleep paralysis and nocturnal fragmented sleep. The clinical diagnosis according to the International Classification of Sleep Disorders is the presence of excessive sleepiness and cataplexy. A full in-lab polysomnography followed by a multiple sleep latency test is recommended for the confirmation of the diagnosis and co-morbidities. The presence of two sleep-onset REM period naps in the multiple sleep latency test is diagnostic for cataplexy-free narcolepsy. A positive HLA-DQB1*0602 with lower than...
Objective: to determine the value of dopamine transporter (DAT) neuroimaging radiotracer in a gro... more Objective: to determine the value of dopamine transporter (DAT) neuroimaging radiotracer in a group of idiopathic rapid eye movement sleep behavior disorder (iRBD) patients regarding the development of a synucleinopathy. Methods: 6 retrospectively selected patients with clinical and polysomnographic diagnosis of iRBD, on treatment or not, were submitted to a single-photon emission computerized tomography (SPECT) with TRODAT. Results: Five from six patients have an abnormal test showing reduction in DAT density measured by the linkage potential on SPECT. Conclusions: TRODAT crosses the blood brain barrier, has a high affinity for DAT and is capture by SPECT. The decreased uptake of DAT tracers means a reduction in dopaminergic activity which suggest the possibility of Parkinson Disease. We have tried to reinforce iRBD as a marker of neurodegenerative disease and suggest SPECT with TRODAT as an easy method in our country to follow longitudinally these patients.
Uploads
Papers by Geraldo Rizzo