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If for some year starts only after Carnival, for many began only in March. Brazilian culture is a difficult change. Actually we are starting the year in earnest this week. Hopefully everyone is with the batteries recharged, with a lot of energy to make this one of the best years of their lives.

But for us to start the year well, patients are the most important to place implants or make your dentures. If for general practice the situation is difficult for implants (if writing in the plural), is harder still (that singular). And something needs to be done to change and not wait for better days, not arriving.

If patients do not come by spontaneous generation, the old theory of Charles Darwin, we need to generate them by artificial insemination, or how stem cells are more fashionable, using concepts of marketing Philip Kotler.

For they do not perceive a need, we have to be subtle. And modern. To much is given an information system implantológicas associated with your database. Fast and cheap, almost free of charge. See how easy it is.

Alcoholism is the leading risk factor for the health of Brazilians

Alcoholism is the leading risk factor for health in Brazil. The information is from the Global Burden of Disease 2010, document organized by the Institute of Health Metrics and Evaluation (IHME) at the University of Washington and partnership with dozens of universities around the world. The result of the overall effort, which will be published today in The Lancet, lists 67 issues that most affect people around the world. On the planet, the greatest evil is high blood pressure, which in 2010, the survey reference, killed 9 million people and affects 173 million individuals.
Each region, however, has a particular list. Brazil was placed in an area called "Latin America Tropical," which also includes Paraguay. The estimate of the study is that alcoholism affects about 5.64 million people in these countries. In 2010, there were approximately 151 000 deaths for the problem. The second risk factor is high blood pressure, responsible for more deaths (about 274 thousand), but that affects around 5.3 million people. Thirdly, obesity, with four million patients and 141,000 deaths this year.
Points in the study, decreased importance of risks related to malnutrition. Infant mortality fell by 60% problem between 1970 and 2010. Increased from 16.4 million to 6.8 million per year.
- For 20 years, people did not have enough to eat. Today, there are lots of food and unhealthy food, even in developing countries - says Majid Ezzati, an author of the study from the School of Public Health at Imperial College London, England.
To the psychiatrist Nelson Caldas, Division of Psychiatry and Medical Psychology, University Hospital Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), the study shows that there was a concern regarding the increase in life expectancy, but not with awareness of healthy habits.
- Alcoholism can lead to many problems like, including obesity and high blood pressure who are at the top of the list - the psychiatrist says Nelson Caldas, Division of Psychiatry and Medical Psychology, University Hospital Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ). - It's a case of thinking up campaigns warning about the problem have been really effective.

Acute Pancreatitis, terrible consequence

Acute Pancreatitis, terrible consequence ...
Acute pancreatitis is a condition resulting from acute inflammation of the pancreas. The main function of the pancreas is to produce digestive enzymes, insulin and glucagon to regulate blood sugar levels.

In pancreatitis, pancreatic enzymes that are normally released in the small intestine to aid in digestion are activated inside the pancreas and start to damage it. If the crisis is severe or prolonged, or if outbreaks of acute pancreatitis occur repeatedly, permanent damage to the pancreas may occur and lead to a condition called chronic pancreatitis.

The two most common causes of pancreatitis are gallstones and bile alcoholism (alcohol abuse). Since the pancreatic duct, which carries digestive enzymes from the pancreas into the small intestine is common to the bile duct, which has gallbladder and liver, gall stones which prevents clogging the canal pancreatic enzymes from reaching the intestine, being accumulated within liver and since being activated, eroding the body inside. Although most people who drink alcohol do not develop pancreatitis, drinking large amounts of alcohol can turn pancreatitis.

Other factors that can sometimes cause pancreatitis include:

Abdominal trauma (traumatic pancreatitis)
Abdominal surgery, drugs, including certain antibiotics (metronidazole, tetracycline and sulfa), thiazide diuretics and estrogen, calcium or High levels of triglycerides in the blood, Some infections, such as mumps or viral hepatitis,
Endoscopic procedures involving pancreatic and bile duct,
Idiopathic (no cause is found).

Symptoms

Symptoms of acute pancreatitis includes:

a Upper abdominal pain which may be tolerable to the piercing in range at the time of the stomach, both right and left;

Projection of the pain to the back, chest, flank or down

Worsening of the pain with food, especially fatty

the nausea and vomiting,

o Loss of appetite

the Abdominal distention (swelling),

The Fever,

o Lack of air

Fatigue,

the hypotension and shock (very low pressure disabling the functioning of organs).


Diagnosis

The patient's medical history will reveal the abuse of alcohol which, when absent, especially in women, is strongly suggestive of gallbladder calculi, confirmed by ultrasound examination.

Blood tests reveal elevated levels of pancreatic enzymes, amylase and lipase confirming the diagnosis of pancreatitis. The decrease in blood calcium signal is worsened, as well as the increase of leukocytes, glucose, urea and creatinine.

In some cases of pancreatitis the blood amylase may be normal as it rises rapidly at first and then decreases, signifying no improvement.

In some cases, a CT scan of abdomen when there is suspicion of swelling of the pancreas and the presence of fluid in the abdomen. A CT scan can also reveal pancreatic pseudocysts that are cavities containing pancreatic enzymes that develop in some cases of severe pancreatitis in chronic pancreatitis. Serious complications can occur when the cysts burst and the enzymes come in contact with the surface of the abdomen (peritonitis).

Prevention

Avoid the abuse of alcohol if the person never had pancreatitis,

Never drink the most, if the person has had an episode of alcohol-induced pancreatitis,

it is believed to maintain a normal body weight and to prevent rapid weight loss may prevent the development of gallstones,

Avoid the indiscriminate use of antibiotics and oral contraceptives-based estrogen.



Treatment


· General Measures:



Rest in hospital

Fasting to "rest" the pancreas,

the replacement fluid intravenously

the passage of a catheter through the nose into the stomach to control the vomiting,

The parenteral nutrition (for a vein thick) may be required in more severe cases,



· Medications to protect stomach ulcers from stress. Includes H2 blockers (ranitidine hydrochloride) and proton pump inhibitors (omeprazole, pantoprazole, esomeprazole, etc.)



· Antibiotics are indicated only in severe cases and when the cause is gallstones by the frequent presence of infection of the gallbladder - cholecystitis.



· Surgery is indicated in the following situations:



the definitive treatment of gallstones (cholecystectomy)

Infection with the documented pancreatic abscess (collection of pus)

The Necrosis (deterioration) wide pancreas,

The major bleeding,

Shock that does not improve

the failure of multiple organs.

Call your doctor?

The patient with severe abdominal pain that does not improve with home measures, or is accompanied by intense vomiting or nausea, you should look for a surgeon general or be treated at an emergency room.

Prognosis.

Pancreatitis often mild improvement in the first week without complications and without any additional problems, but severe cases can last several weeks. Chronic pancreatitis may develop if there is a significant lesion of the pancreas or if the patient had several attacks over time.

Nearly 10 percent of patients develop complications such as abscesses and necrosis of the pancreas that may require surgical treatment.

The pancreatitis caused by alcohol in crises occur from time to time, if the patient insists on drinking. Approximately 10 percent of patients with acute pancreatitis develop alcohol-related chronic pancreatitis.

OPERATE OR NOT OPERATE the GALLBLADDER? The EIS ISSUE

OPERATE OR NOT OPERATE the GALLBLADDER? The EIS ISSUE


When working and silent, the bleb is where is stored bile, a greenish liquid, bitter and slimy, secreted by the liver and which, through its own system of channels, led to the duodenum, participating so important digestion. But, sometimes, one dysfunction, a change occurs in the production of bile, the formation of precipitate crystals, which, little by little increasing in size and will give rise to so-called gallstones. Most people who have no symptoms calculations. Although laparoscopic surgery is widespread, it is only indicated in certain cases. What is the evolution of asymptomatic gallstones? The frequency of symptoms and complications of gallstones discovered by chance is relatively small. In general, those with gallstones never present symptoms or complications from calculations asymptomatic gallstones. Still, many researchers have been trying to establish which patients could present problems bile throughout his life. To our knowledge, there seems no relationship between symptoms and age, sex and number of calculations. So far, there is consensus that the evolution of the calculations that have no symptoms is benign and requires no intervention. What is the evolution of symptomatic gallstones? Moreover, since the calculations cause typical symptoms of biliary disease, risk of persistence of the problems is relatively high. Moreover, most of the complications of biliary calculus disease is preceded by an attack of biliary colic. Therefore, since the patient had biliary colic, the trend is that these episodes recur to culminate in some complication, if nothing is done. As the biliary colic manifests? The main complaint of patients with symptoms is biliary colic. Most clinicians agree that biliary colic - the most characteristic symptom of calculating gallbladder - is not an appropriate name because the pain is not the cramping. Rather, it is a very intense and continuous pain in the upper abdomen, and during which alternate periods of worsening and improvement. This pain lasts from 15 minutes to hours and is commonly accompanied by nausea and vomiting. Frequently evolves without precipitating factors. The interval between episodes can vary from days to months or even years, and rarely, daily symptoms can be attributed to gallstones. The biliary colic should be distinguished from nonspecific symptoms that characterize functional dyspepsia. Gas, heartburn, abdominal discomfort, intolerance to fatty foods are frequent complaints in clinics. However, both occurring in patients with stones as in patients without gallstones. This differentiation is critical to successful treatment, since this is only indicated for biliary colic. In the episode of biliary colic without complications are not detected changes in laboratory tests. The main test to confirm the diagnosis of gall calculation is the abdominal ultrasound. What are the main complications of gallstones? When the framework persists for more than six hours, the suspicion of acute cholecystitis should be rejected. Most patients with acute cholecystitis have previous episodes of biliary colic. The pain of acute cholecystitis is more prolonged, can be located more precisely on the right side of the upper abdomen and is associated with fever. In the presence of acute cholecystitis, a gallbladder wall is thickened on ultrasound examination. Once the vesicle becomes inflamed, signs of infection and elevated liver enzymes appear in blood tests. In some patients, the calculations can escape from the vesicle. If they are small, they can pass through the bile ducts to the gut, leaving faeces. If they are slightly larger, can become lodged in the bile ducts, causing complications such as jaundice, cholangitis or pancreatitis. The obstruction of the passage of bile results in jaundice (yellowing of skin and whites of the eyes) and itching. Calculations in the main bile duct are frequently associated with infection, resulting in the serious situation of acute cholangitis, which is characterized by biliary colic, jaundice, fever and chills, requiring urgent treatment. Acute pancreatitis (inflammation of the pancreas) can also be caused by passing through the channel biliary calculi. Some experts recommend the removal of the gallbladder with calcified walls (also called vesicle porcelain) the risk of developing bladder cancer. Although calculations (larger than 3 cm) may be associated with bladder cancer, withdrawal prophylaxis is still controversial. What is the best treatment option? There is consensus that the calculations should not be treated asymptomatic. Only calculations with symptomatic or calcified gallbladder complications and should be treated. Options include surgery (cholecystectomy), dissolution or fragmentation of the calculations. Surgery is the only definitive treatment. It is a simple and safe surgery, and indicated for most patients with stones. Currently, laparoscopic cholecystectomy facilitated the procedure with a shorter hospital stay, fewer complications and quicker return the patient to their routine. It is for this reason that cholecystectomy has become choice for most patients with gall stones. However, in about 5% of cases and the presence of complications, the conventional cholecystectomy may be a better option. The non-surgical treatment is reserved for patients who do not want to undergo surgery or have a very high surgical risk. Importantly, both the dissolution as the fragmentation of the calculations are not definitive procedures. As the bladder is not removed, the calculations can, over time reappear. The calculations present in the bile ducts can be removed through an endoscopic examination, called endoscopic retrograde cholangiopancreatography (ERCP). This test may be performed before, during or after cholecystectomy. Symptoms may persist after cholecystectomy? The persistence of symptoms after cholecystectomy should be observed and discussed with patients before subjecting them to surgery. Many physicians tend to indicate the occurrence of cholecystectomy versus nonspecific symptoms such as intolerance to fatty foods, gas, belching, heartburn, nausea. Although some patients may improve such symptoms after surgery, several studies have shown that these may be present in the presence or absence of gallstones, and therefore are not disease specific bile. Perform a cholecystectomy just to see if these symptoms improve is not recommended. Furthermore, the cholecystectomy procedure is not innocuous and may cause other symptoms such as diarrhea post-cholecystectomy. For the broad spectrum of clinical presentations, the possibility of improvement in some patients and ease offered by laparoscopic cholecystectomy, surgery may even occasionally be required in patients with such symptoms, provided they are intolerable have negative investigation for other causes, or the subject has been previously discussed with the patient and the same has accepted the possibility that the symptoms are not relieved by surgery.

Surgery for Gallbladder

We receive many questions about when the post surgery can return to have sex .... Friend, when you realize, sex will not affect the surgery, but it is clear that after the person becomes weak, in pain, so .. it's good to give a team a while.

But know that the stones arise when there is an imbalance between the amount of water and substances in bile, promoting solidification thereof. Can occur due to lack of water or excess of some components, particularly cholesterol and pigment.

The main risk factors are:

* Age: uncommon in young people, the risk of developing cholelithiasis (gall calculation) is 4x higher after 40 years.
* Sex: A gall stone is 3x more common in women than in men. From 60 years this difference falls drastically, also by falling estrogen levels.
* Pregnancy: by excess estrogen during pregnancy
* Hormone replacement: also by estrogen
* Obesity is a major factor in young people, especially girls
* Family history: 1st degree relatives with a history of gallstones increases at 2x the risk.
* Rapid weight loss: major weight loss in a short time or very low calorie diets are also risk factors
* Diabetes
* Cirrhosis (read: Liver Cirrhosis - Causes and Symptoms)
* Prolonged Fasting: the longer the duration of bile in the gallbladder, it becomes more dehydrated and the greater the risk of stone formation

brown discharge

Not all cases of brown vaginal discharge are cause for concern. As a woman you are probably aware of the general condition of any discharge 'down there'. The discharge range runs the gamut from irritating, awkward or inconvenient. Occasionally however what you observe in their private moments hygiene can be worrisome. This is the case for most women do when they discover that the red or runny course it's normal, but a dark reddish brown colored discharge.
During menstruation, many women suffer from physical ailments such as abdominal pain, mood swings and cramps. The duration of menstrual bleeding 4-7 days may be sufficient frustrating and can interfere with normal activities. Some women experience light brown discharge prematurely, which sometimes can be very annoying. Before the onset of menstruation, or period, as is commonly known, some women obtain vaginal fluid, which is similar to menstrual flow. The only difference is that this file is tan or brown in color unlike the normal bright red menstrual fluid. Normally, this download comes a week before the period begins, but may also occur between the menstrual cycle. Very often, brown vaginal discharge takes endometrial tissue, which the old are expelled outside the womb. If the period is delayed, some women may notice a brown discharge instead of the normal.
The causes of the discharge period before Brown
There are many reasons to take a brown tint in the download, one is a delay in the regular menstrual cycle. Below are some of the causes of coffee (or brown) discharge before period;
Menstrual fluid is old blood, nutrients and a layer of the endometrium. In some cases, only the endometrial layer is discharged from the vagina, which is brown. This is one reason why some women experience brown secretion before their periods.
Taking contraceptive pills or birth control can alter the proper functioning of the two main female hormones, estrogen and progesterone. Birth control pills have the ability to affect the production of hormones in the body, especially during menstruation and pregnancy. These pills also change the level of hormones. If these pills have left or if a woman stops taking the pills according to the prescription, so she can experience a brown discharge before period birth control.
One of the first signs that a woman is pregnant is implantation bleeding, which is also known as the introduction of location. Signs of bleeding during implantation occurs when the fetus implants in the lining of the uterus called the endometrium and causes a tear in the lining, leading to the introduction of spotting that is pink or brown. Implantation bleeding occurs for about 2-3 days, and it shows after ovulation, or before the next period.
Another reason for the appearance of brown discharge may be due to the presence of polyps. Polyps, also known as tumors are abnormal growths in the uterus and are benign in nature. The bleeding in the uterus because the polyps causes release discolored.
Treatment Options
As brown secretion before menstrual cycle can be caused by several reasons, different methods for treatment thereof. If you experience a download that does not look normal, then it is advisable to consult a gynecologist, who can diagnose the exact cause and prescribe the necessary drugs. You may also have to undergo a Pap test to check for polyps or other abnormal growths in the uterus. The growth of these polyps can be inhibited with the help of certain medications, but in rare cases, surgery may be an option. If you are on birth control pills and experience a shock, then the doctor may advise you to switch brands or prescribe pills that are suitable to your body.
Although brown discharge before period does not lead to complications, it is necessary to stay healthy and practice a healthy lifestyle in order to alleviate the problems associated with the menstrual cycle.

The sciatic nerve

Many people, at least once in life, suffering from pains in the sciatic nerve. This pain can reach any point of the nerve runs from the buttocks to the feet, usually lasts a week or two, and may return later. Treatment for pain sciatic nerve is most commonly used to stimulate the patient to keep it active, doing excercícios for example.

sciatic nerve

Symptoms of sciatica pain are most common; sharp pains that go down by one or two legs and get worse as you move, muscle weakness in the affected region or tingling in the affected leg. The causes of these pains are related to sudden efforts in the column, change in posture due to the pregnancy and abnormalities in the sciatic nerve itself.

To that end or reduce these pains is desirable to apply an ice bag wrapped around his lower back, 50 to 10 minutes each hour. Taking painkillers and putting a hot water bottle on the affected area is also advisable. Keep yourself active, practicing excercícios for the lower back is also a good tip, even as prevention. Following the tips mentioned above you will decrease or even annihilate the sciatica.
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Bodybuilding is something important to combat the pain of the sciatic nerve

Physical exercise is something that has become as important as drugs in treating diseases such as osteoporosis, osteoarthritis and rheumatoid arthritis. No wonder, it is estimated that the frequency of people over 60 years in the gyms has increased about six times in the last ten years.
An eye on this vein, many businesses have formed partnerships with doctors and offered special discounts and activities for older people referred by them. Appeared to specialize in public gyms, with their own medical staff and facilities suited to those with reduced mobility (more information on this page).
The boom began after proof, in the beginning of the last decade, that exercise overload are able to prevent the advance of osteoporosis, says Kleber Pereira, president of the Association of Academies (Acad). "The doctors started to recommend weight training for seniors, who now represent nearly 30% of our students."
Recent studies have demonstrated the benefits of weight training to another problem that affects nearly 60% of people over 60 years with osteoarthritis. Characterized by wear of the joints, the disease causes pain and restricts movement.
Myths. "Until recently, patients with osteoarthritis were given the recommendation to do only light activities and avoid heavy lifting or climbing stairs," says Julia Greve, coordinator of the Laboratory of Movement Studies (LEM), Faculty of Medicine of USP.
But today we know that strengthening the muscles reduces the load on joints, reduces pain and restores range of motion.
Another myth that has been overthrown by a survey conducted in the LEM is that the elderly do not respond as well to exercise as younger people.
The team coordinated by Julia followed three groups of women over 13 weeks of strength training. The first was composed of elderly with osteoarthritis in both knees that had undergone surgery for placement of a prosthesis in them. The second was no older joint problems and the third, healthy young adults.
Four questions were evaluated before and after 13 weeks: the distance walked in 6 minutes, the speed with which they climbed a flight of stairs, the time it takes to stand up and sit in a chair and the time to get up from a lying position. All in all, the group of women with joint problems was the most evolved. Also this group was the most able to increase the overhead during the study period and improve balance.
The story of Antonio Carlos retired Amabile, 72, is proof that, regardless of age and the initial condition, you can always improve with physical activity. In 1999, he had to undergo surgery to remove the femoral head because of an abscess. "The doctors thought it best not to put the prosthesis because of diabetes. They were afraid of rejection," he says. After two years of physical therapy, he had the backing of the team to weight training.
"In the beginning, came to the academy of a walker and had to do the exercises without weight. Gradually I recovered everything. Today I go up and down stairs with ease. I am independent, it has yet to use a cane."
Amabile feels at home in middle marombeiros girls and thick thighs. It is so popular among colleagues who became the poster boy network of academies Level A. "The social part is important. Let us stimulated. I miss when they come."
Kokichi Takano, 76, is another who has already incorporated in the workout routine. Four times a week, he devotes two hours to engage in weight training, stretching and treadmill. On weekends, go to Ibirapuera Park walk. "I started training regularly for 70 years. He suffered from arthritis and had severe pain in the sciatic nerve. Now do not feel anything anymore," he says.
Ideal training. Fabio Jennings, rheumatology and sports medicine specialist at the Federal University of Sao Paulo, says that the ideal training for the elderly should include aerobics, to help control body weight, muscle strengthening and stretching to improve flexibility. "It is also important to add activities that work balance. This decreases the risk of falls and consequently fractures."
Not always, however, people with joint problems can achieve this goal at the outset. "Often just get through the gym and then the pain decreases, we enter with walking and stretching exercises," says physical education teacher Emmanuel Gomes Ciolac.
The secret of physical activity in patients with health problems is knowing what to do, how to, with which load and intensity, says Julia Greve. "It's an individualized prescription. Because of a drug."

sciatic nerve pain

About 15% of the population suffers from pain due to sciatic nerve problems. The sciatic nerve is the main nerve of the lower charge of the hip, knees, ankles, hamstrings, calves and feet.

The sciatic nerve is formed by two nerve roots that leave the spine and down to the lower limbs, as part of their sensory and motor innervation. The great pain occurs when a nerve root compression of the lumbar spine, which can cause numbness, sciatica, motor paralysis and in severe cases to the strength deficit.

A major problem is the sciatic nerve inflammation, which provides strong pains that go from the back of the thigh to the back of the calf and can extend to the hips and feet. It can be developed by various factors such as poor posture, certain types of infections and tumors, back problems, such as herniated disk, and also in pregnancy.

Problems in the sciatic nerve can occur in people of all ages and, above all involve the joints, one of the most effective methods for treating disorders of the sciatic nerve is the analytical therapy - a normalization method to articulate fully manual that treats and prevents diseases promoting a better quality of life for patients.

According to Maria Luiza Pereira Biton Gutierrez, director of the Institute for Analytic Therapy, to serve such patients, we conducted a thorough radiological examination in which specific tests are done to determine which is the joint damage. From the result of starting treatment techniques with gentle positioning of joints involved.

- In fact, conventional techniques are going to treat pain without asking what is its origin. They will do anything to relieve it, but without really solving the injury that caused the symptom. Since the analytic therapy is actually more effective than traditional treatments because it develops the correct biomechanical rhythm of injured joints. We are having great results in our clinical experience - Maria Luiza explains.

Nerve pain

Cure sciatica
The level of medicine, common treatments are analgesics and anti-inflammatory as well as physiotherapy.

However, it is worth noting that these treatments only act on the pain and not the cause of the problem so it's only a matter of time until the problem back again.

The level of so-called alternative medicine (complementary), which usually give better results in spite of osteopathy is the only address one of the causes which tend to be behind the sciatica.

Other approaches that often must be applied are the visceral manipulation, cranial sacral therapy (or cranio sacral), myofascial release and many more according to the real causes that lie behind the sciatica.

Unfortunately most medical tests do not detect the real causes behind sciatica and so the treatments are not the most suitable.

As to alternative medicine (complementary) they have the body and the problem according to their point of view and thus fall far short of what it takes to deal with and resolve the causes behind sciatica.

This way or the person who is to understand and learn to solve the causes behind sciatica or have to resort to many different approaches (medicines, therapies, etc.). To address the many causes that lie behind the sciatica.

Deivid recovering from problems in the sciatic nerve

It was the 2010 Brazilian Flamengo and did not get anywhere, I had no goals. At the end of the transfer window came Deivid. The urgency has to face negotiation. To critics, the pay was high. He was idle, but the team had no time to wait. Without preparation and with a sciatic nerve problem, the performance did not come. The world fell on his back. About to get another chance as a starter against Botafogo, Deivid impressed by how frankly admits the doldrums. But it also ensures that on the horizon, he sees gains for Flamengo

Embezzled the sciatic nerve Botafogo Rio

Uruguayan striker Loco Abreu is recovered from the pain that was felt in the lumbar region, in fact the result of an inflammation of the sciatic nerve. Thus, the medical department released the Botafogo player who, after missing two games, may return to timenesta Wednesday against the New Delhi, in a match valid for the second round of the Rio Cup

The casting Botafogo, however, is not yet confirmed. It depends on the coach Joel Santana, with the player seems to have finally settled, as both are keen to demonstrate during training, with short but lively - discussions.

The activities of the morning Monday, Loco Abreu norlmalmente attended the training, although among the reserves. Break, scored two goals.

Romerito back pains in the sciatic nerve and leaves crying training

The situation of the largest idol in the history of football from Pernambuco, the half Romerito Goiás, seemed resolved. He has trained for a week and usually also expected to return to their lawns very soon, but everything changed on the afternoon of Friday. The player participated in the mini-collective when he felt the pain in the sciatic nerve that had been bothering him since early February. A pain so strong that he left the field crying.

According to the club doctor, Amilton Croci, Romerito was responding well and no longer felt pain. Now he must make a new MRI to analyze the problem better. The dignóstico is the same: sciatica, an inflammation of the sciatic nerve. "It's the sciatic nerve that gives power to the muscles. The pain is very strong and radiates throughout the lumbar region and other parts of the body," he said.

The problem may be related to a herniated disc that had Romerito and operated until 2009, when he was in Goiás In years past, half felt a thigh muscle injury that kept him out of the season. He just recovered from injury earlier this year.

Court acquits accused more than condemn malpractice

The Sao Paulo Court acquits more than condemn professionals accused of malpractice. A survey conducted at the Court found that in the first half of this year the number of appeals against doctors were dismissed reached 65%, remaining sentences of the first degree, while the percentage of conviction was the order of 35%.

"The cases of medical errors s emblematic and not always transparent to the truth emerges clarification of the judges," said Judge Ernie Zuliani, of the Court of St. Paul, an expert on the subject. According Zuliani, in the case of medical malpractice, the duty to prove it is the part that points to the supposed guilt of the professional.

Error would be the fault of the physician in the practice, either because they did what I should do because he did the wrong thing, or because he wrongly or mistakenly that it was his duty.

The latest study on the subject was published in 2007 by the Regional Council of Medicine of São Paulo (Cremesp). The survey collected data from seven years between 2000 and 2006 and showed a 75% increase in the number of complaints against physicians.

Also according to the study of Cremesp, medical error accounted for 35% of all complaints received and 43% of cases against professionals from São Paulo. The local authority company promises to the beginning of August to update this study.

An estimate by the National Association of Private Hospitals and quoted by the lawyer Philip Lisbon Capella realizes that one in ten physicians in Brazil respond or have responded to malpractice lawsuits.

Damage to the beauty

In the survey conducted in São Paulo Court of Appeals surveyed the number reached 40. Of all kinds of medical procedures led to litigation, most cases involve alleged errors in aesthetic surgery, obstetric and bariatric. Patients claim compensation for moral damages, materials and aesthetic.

This was the case of a patient who underwent plastic surgery to change in a breast implant clinic in Sao Paulo. Occurred the so-called asymmetry (the patient's right breast was higher than the left). The 3rd Chamber of Private Law understood that there were guilty of medical malpractice in the sport.

The foundation is the conviction that this type of surgery there is a contractual obligation to respect the result. "The bottom cover plate due to the obligation assumed, in the open, has not been achieved," said the rapporteur of the appeal, Judge Donegá Morandini.

For the judge, when the expected does not happen by the patient contracted the doctor has a duty to indemnify it, on account of frustration embittered by the lack of success in surgery.

In this case, the doctor was ordered by the judge of first instance to pay moral damages amounting to 25 minimum wages (about $ 12,500). The gang headed by judging the amount found Morandini narrow, doubled its value.

Burden of proof

The Sao Paulo Court judges the cases of malpractice liability by applying the Consumer Defense Code (CDC). The consumption ratio in the provision of professional services is interpreted as being subjective, or depends on proof of fault of the doctor.

The judge Beretta da Silveira, president of the 3rd Board of Private Law of the Court of São Paulo, explains that any event that brings legal repercussions can be proved in several ways: confession, submission of documents, witness statements and expert opinions.

He points out that the rule is that any fact stated in court shall be proved by those who claim (the so-called burden of proof). That is, the duty to prove the existence of damage in which the plaintiff relies competes with it, which can be direct or indirect victim of the damage.

A woman in the city of Franca sued the doctor accused of being responsible for the entry in your binder / prenatal medical records that would be HIV +. She also blamed the doctor, with the notation, cause the breakup of his marriage, and because of the concussion suffered by the separation, so the abortion of the fetus.

The Court recognized that there was a wrong note in the chart, but it was momentary. The blood test came back positive for syphilis and negative for AIDS. The doctor changed the information recorded on the card service, but soon rectified the error.

For the Court, the patient has exaggerated the charges and failed to prove that the attitude of the doctor caused all the problems pointed out by it. "You can not give the defendant the responsibility of destroying the marriage of the author or with abortion," explained Sebastian Judge Carlos Garcia, of the 6th Chamber of Private Law.

Doctor or hospital

Another issue that is at peace at TJ Paulo is the understanding that the professional has no liability when the damage occurs by failure of the hospital.

This understanding can be illustrated by the conviction of one of the most renowned aesthetic clinics in the country. The company was obliged to indemnify a patient who has scheduled a plastic surgery to correct the abdomen and liposuction. In the same decision, the Court exempted the medical liability.

The client account that arrived on the scene early in the morning, with eight hours of absolute fasting, but only received medical visit at 19h, after almost 20 hours without eating. When was anesthetized vomited, had aspired to the secretion and respiratory arrest. He was rushed to the ICU of another hospital, where he was admitted.

The victim filed a lawsuit against the doctor who attended the clinic and against. The Court held that there was "inexcusable failure" of the clinic, which caused the suffering patient, but found no error in the conduct of the doctor.

For the class that dismissed the action, one would expect a clinic willing renowned not only adequate means to prevent incidents like what happened, but to give proper treatment to the victim of such an occurrence.

"After all, anyone who built a clinic in default, although aware that any surgery involves a risk, will imagine that the whole structure of equipment and services necessary to avoid the risk, mitigate the consequences and deal with them until the hazard is completely removed, "said Judge Ricardo Pessoa de Mello Belli, rapporteur of the resource.

Foot drop

In another case, the 4th Chamber of Private Law absolved of responsibility Araraquara a doctor, accused of alleged error in surgery to remove a cyst in a woman. The patient accused the doctor to remove the tumor of the knee have cut the sciatic nerve which caused her so-called "foot drop".

In the first instance decision, the judge took into account the expert report. The patient appealed accusing the expert corporatism does not recognize the failure of the orthopedist.

The Court acknowledged that the report was correct and accepted the doctor's version of what occurred, in fact, was an iatrogenic. That is, the nerve that causes the effect of "foot drop" lost its inertia, the result of inflammation unmatched by surgery.

The chamber decided to acquit the doctor for absolute lack of proof that the surgery acted with recklessness, negligence or malpractice. "The doctor in this case was not required to cure the patient or avoid the harmful effects of nerve involvement by compression of the cystic tumor," argued the rapporteur, Ernie Zuliani.

Remedy for Sciatic Nerve

The sciatic pain are more common than cold. Hard to find someone who has never suffered from back pain and legs, being forced to stay home for days. Global estimates indicate that 90% of the population suffers or will suffer from the problem at some stage in life. "Overweight and poor posture are two factors that contribute to the growing number of patients with inflammation of the sciatic nerve," said Dr. Wajih Abud Hares, Technical Director of the Hospital San Paolo.

In the interview you read below, the expert teaches how to deal with the pain, speaks of situations in which surgery is the solution and discusses the effectiveness of complementary treatments such as acupuncture and RPG.

How to identify the sciatic pain?
The pain may be felt as a dull, aching or burning. Sometimes it starts gradually, worsens at night and is aggravated by motion. Sciatica can also cause numbness, paresthesias (low sensitivity) or muscle weakness in the affected leg, before attending to the pain and tingling.

People with older age are more prone to the problem? Why?
Yes, because they forced up the column over the years. Over time, intervertebral discs lose their ability to absorb impact, making it more easily subject to injury and causing disturbances in the mechanics of the spine, including the loss of water (natural and essential for the maintenance of records intervertrebrais ). Also affect the weight distribution in the column, damaging structures such as the intervertebral joints and ligaments. These as part of the defense against aggression, tend to be hypertrophied (these are called bone spurs). The increase of the joints and ligaments that make up part of the spinal canal ends up reducing the diameter of the channel, leading to compression of the spinal cord or nerve roots, with the possible compression of the spinal cord or nerve roots that give rise to.

Sciatica, which is the best treatment? What is ?

Sciatica or sciatic pain (more commonly known as sciatica) is a disabling and severe pain due to nerve inflammation ciático.A inflammation of the sciatic nerve can cause severe pain from lower back to the foot often impossible to walk and the person it often to movimentar.Causas: Some of the causes of sciatica may be due to several factors such as uneven hérniasbacia (see video). short leg (see video) problems muscularesproblemas visceraisoutros factors Treatments:

The medical grade treatments are common analgesics and anti-inflammatory as well as fisioterapia.No However these treatments only act on the pain and not the cause of the problem so it is only a matter of time until the problem back again. The level of so-called alternative medicine (complementary), which usually give better results in spite of osteopathy is the only address one of the causes which tend to be behind the ciática.Outras approaches that often must be applied are the visceral manipulation, therapy cranial sacral (sacral or skull), myofascial release and many more according to the real causes that lie behind the sciatica.

Unfortunately most medical tests do not detect the real causes behind sciatica and so the treatments are not the most indicados.Quanto alternative medicine (complementary) they come from the body and the problem according to their point of view and thus are far short of what it takes to deal with and resolve the causes behind the ciática.Desta form or find the person who understands and knows address the causes behind this problem or has to resort to many different approaches (medicines, therapies, etc..) to address the many causes that lie behind the sciatica.

New approaches and visions:

Causes: Knowing that the fascia can create compressions of up to 140 lbs per square inch, you can imagine what this represents in the lower back and on the nerve ciático.Com such compression is more than obvious that the pain, and changes in terms of vertebral discs, vertebrae, pelvis, leg, etc.. many more are causing too much pain and too problemas.As tensions at the level of tissues cause pain and discomfort at all levels causing sciatica is one of the problems that affect too many people.

In my experience with this and many other situations I can say is that in fact they are resolved in a way and faster when you know what to do in each situação.O is always more important to get to know what the real causes behind a given but this problem can only be achieved with knowledge, sensitivity and great to know that there experiência.Depois approaches, therapies, medicines, etc.., apply to correct the causes that are behind the problem and here too there is to know and meet many of these approaches and solutions so that we can be able to correct these causes.

In the background correction is not only due to the application of a particular approach but rather if they can detect the causes behind the problem and then apply what they learn and how to apply the best solutions to the problem and its causas.E this can only be achieved with practice, knowledge and a lot experiência.Eu use many different approaches in my work either detection or correction because only this way the results are possible and happen as quickly as intended.

When surgery is required - operation

In most patients with sciatica has an excellent response to conservative treatment, without requiring any type of surgery. However, there are some situations in which the procedure is necessary:

When there is dysfunction or urinary visceral caused by compression of the spinal cord or its roots.

When there is severe stenosis symptomatic and refractory to conservative treatment and their specialist decide that surgery is the best treatment.

If there are progressive neurological disorders such as weakness in the legs, for example.

If symptoms become severe and conservative treatment is not effective in improving the quality of life.

The spine surgery is a delicate procedure and should preferably be done by a specialist trained and certified by the Brazilian Society of Spine and experienced in the technique being used.

There are several types of procedures that can be made. The type of procedure is dependent on several factors and needs of the patient. The surgeon must take into account the medical history, age, physical condition, occupation and other factors.

The main purpose of the surgery are pain relief, restoration of nerve function and spinal cord and the prevention or termination of the abnormal movements of the spine.

There are several types of surgical procedures for the treatment of sciatica. Your specialist will recommend the best procedure for you and remember that the final decision should always be yours.

Two of the most common procedures are:

Dissectomia or Microdissectomia: The surgeon removes part or all of the herniated disc causing nerve root compression. The difference between these procedures is that microdissectomia is a minimally invasive procedure, but your statement is more restricted.

Laminectomy or laminotomy: These procedures are based on partial or total withdrawal of a portion of the vertebra called blade that protects the spinal canal and spinal cord and its roots. These procedures may create more space for the nerves thus reducing the likelihood of chest compressions.

Sciatic Nerve - which doctor should I look?

Having caracyerísticas Nerve Sciatic pain, make an appointment with an orthopedic doctor if sciatica worse after a few days or if it begins to interfere significantly with your daily activities. Call your doctor immediately if you experience a sudden, extreme weakness in his legs, numbness in the groin or rectum or difficulty controlling bladder or bowel function. These symptoms may indicate that the nerves to the pelvis are compressed.

CAUTION:

This condition can cause permanent damage if not treated promptly.

Sciatic Nerve Treatment - how to heal

The terrible sciatica can usually be successfully treated for a brief period of rest and decreased activity, followed by exercises to improve mobility and strengthen the back. If symptoms persist, physical therapy may be helpful. To relieve the inflammation around the nerve, it is recommended that you alternate using hot and cold compresses.

You may also need to take a painkiller such as acetaminophen (Tylenol) for pain or anti-inflammatory drugs like naproxen (Naprosin) Diclofenado (Voltaren) or aspirin to relieve pain and inflammation. Medicines to treat chronic pain of nervous origin may be useful. They include amitriptyline or gabapentin (Neurontin). In more severe cases, an injection of a long-acting anesthetic with a steroid medication can provide relief. These injections are typically performed in centers that specialize in treating pain. Rarely, surgery is needed, for example, when the sciatica is caused by a herniated disc.

Sciatica - how to prevent - what prevention?

There are some exercises, stretches and other measures that can prevent sciatica. A physical therapist can develop a complete, personalized program. Here are some steps you can follow:

· Practice good posture: Stand up always with the head aligned with your shoulders, your shoulders aligned with your hips and your buttocks tucked curvature. Your knees should be slightly bent.

• Do Abdominal: These exercises strengthen the abdominal muscles that help support your lower back. Lie on the floor with his back, hands behind your head and knees bent. Press your lower back to the floor, lift your shoulders up about 30 cm. above the floor, then lower them. Repeat 10 to 20 times, once a day.

· Path / swim Walking and swimming can help strengthen your lower back.

· Lift objects properly: Always lift from a squatting position, using your hips and legs to do the heavy lifting. Never bend over and lift with your back (lumbar region).

Avoid sitting or standing for long periods: If you sit at work, take regular breaks to stand and walk a little.

· Use proper posture to sleep: Take pressure off your back or side sleeping with a pillow under your knees.

· Extension: Sit in a chair and bending movements with his hands toward the ground. Stop when you feel a slight discomfort, hold for 30 seconds, then relax. Repeat six to eight times.

Avoid using high-heeled shoes. Shoes with heels over 2.5 inches high shift your center of gravity, making the body out of alignment.

Sciatica Pain - What is the diagnosis

Your doctor will ask if you have back pain that spreads to the leg, and if you have muscle weakness in your legs or feet. It will also wondering if you had any trauma, fever, problems controlling your bowels or bladder, if you had cancer of any kind in the past and if you lost weight in recent days. These questions are important because if these symptoms are present, the cause of sciatica can be a serious problem, such as a bone fracture or an infection.

The doctor will examine you, paying special attention to your spine and legs. He may ask you to perform a series of tests that will check your muscle strength, your reflexes and flexibility, look for problems in your spinal column and related nerves. He may request X-rays, computed tomography (CT) scan or an examination of magnetic resonance imaging (MRI) to rule out problems in the vertebrae (spine) - she may be angry or may be compressing your sciatic nerve.

The diagnosis is based primarily on your symptoms, although a physical examination is important to look for evidence of nerve injury or other explanation for the symptoms. However, a normal physical examination is common in people with sciatica. While testing may be important in some cases, the diagnosis can be made even when the results are normal.

What causes compression of the Sciatic Nerve?

The dissociative nerve damage is rarely permanent and paralysis is seldom a danger as the spinal cord ends before the first lumbar vertebra. However, an increase in the trunk or leg weakness, bladder or incontinence and / or intestines is an indication of Cauda Equina Syndrome, a serious disorder requiring emergency treatment.

The Lumbar spine disorders known to cause sciatic nerve compression include:
• Herniated discs are the most common cause of sciatica in the lumbar spine.
• Degenerative Disc Disease, a natural biological process associated with aging, is known to cause disc weakness and may be a precursor to a herniated disc.
• Lumbar Spinal Stenosis, a narrowing of one or more neural passageways due to disc degeneration and / or facet arthritis. The sciatic nerve may become impinged as a result of these changes.
• Isthmus Spondylolisthesis results from a stress fracture often at the 5th lumbar vertebra (L5). The fracture combined with disc space collapse, could cause the vertebra to slip forward on the first sacral segment (S1). The slip can cause a pinching of the nerve root at L5 leaves the spine.

The Spinal Tumors and Infections are other disorders that may compress this nerve, but are rare.

There are other conditions that may occur, and may look like a sciatic nerve pain, but are difficult to diagnose.

What are the symptoms of sciatica?

The bad Sciatica usually affects one side of the body. This pain may be dull, sharp, burning, or accompanied by intermittent shocks of shooting pain beginning in the buttock and extending down the back or side of the thigh and / or leg. The Sciatica then extends below the knee and can be easily felt in the feet. Sometimes symptoms include tingling and numbness. Sitting and trying to raise can be painful and difficult. Coughing and sneezing will certainly intensify the pain.

What is sciatica ?

The famous term sciatica is commonly used to describe the unpleasant pain that travels along the sciatic nerve. The sciatica is a symptom caused by a disease that occurs in the lumbar spine. The sciatic nerve is the largest nerve in the body, about the diameter of a finger.
The sciatic nerve fibers of the call begin at the 4th and 5th lumbar vertebrae (L4, L5) and the first few segments of the sacrum. The nerve passes through the sciatic foramen below the Piriformis muscle (rotates the thigh laterally), passes through the posterior hip and bottom of the Gluteus Maximus (muscle in the buttock, thigh extension). Then, the sciatic nerve extends vertically downward and the back of the thigh, anterior to the knee branching into the hamstring muscles (calf) and further down to the feet.