The relationship between headaches and sleep disturbances is complex and difficult to analyze. Both symptoms may have causal relations, or may be associated in the same patient with mutual reinforcements. We studied 25 patients presenting with morning or nocturnal headaches. Standard headache diagnosis and polysomnography were performed. After polysomnography, the diagnoses were reevaluated. The main headache entities were cluster, chronic paroxysmal hemicrania, migraine, tension, combined headache, and chronic substance abuse headache. For each group, headache, sleep data, and changes in diagnosis are discussed. The diagnosis was changed in 13 patients; the final diagnoses were periodic movements of sleep, fibromyalgia syndrome, and obstructive sleep apnea. The diagnoses of cluster headache and chronic paroxysmal hemicrania were not modified by polysomnography. The migraine and tension headache groups had a relative male preponderance, and the diagnosis was changed in approximately half of the patients. This was also observed in combined headaches. Patients who had chronic substance abuse headaches had mainly insomnia, which in some cases, was relieved by stopping medication. Data were also analyzed in terms of simple models linking headache and sleep disturbances. Such an approach allowed the identification of several modes of mutual interaction. In summary, morning or nocturnal headaches are frequent indicators of a sleep disturbance and their presence might justify polysomnography, and the use of simple clinical models may be useful for understanding the complex relationship between headache and sleep.

Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

Headaches occurring during the night or early morning are often related to a sleep disturbance.

Introduction: Powerlifting (PWL) is a worldwide method, frequently used in resistance training programs. However, the relationship between cardiovascular responses and PWL is still unclear in the literature. Objective: To evaluate acute cardiovascular overload and post-exercise hypotension (PEH) after acute powerlifting exercise session in subjects with experience in the modality. Methods: Nine powerlifting athletes (34 ± 5 years) participated voluntarily in this study. The following exercises were used in the session: squat, bench press and deadlift (95% of 1 RM, 2 to 5 repetitions). The anthropometric parameters and blood pressure (systolic, diastolic and mean) were evaluated immediately, 5' , 10' , 30' , 60' and 24 hours after the exercise session with a non-invasive automatic pressure monitor. Results: Significant differences (p<0.05) were found between rest and immediately after exercise on systolic (135 ± 6 vs. 153 ± 10 mmHg) and mean (102 ± 3 vs. 108 ± 3 mmHg) blood pressures, but no difference was found at diastolic (85 ± 3 vs. 85 ± 4 mmHg) blood pressure. Additionally, the increase in systolic pressure did not reach values considered as a risk of cardiovascular overload. Significant PEH was found after 60 minutes (systolic: -12 ± 12%, diastolic: -5 ± 6% and mean: -7 ± 5%) and 24 hours after PWL session (systolic: -5 ± 4%, diastolic: -8 ± 4% and mean: -7 ± 3%). Conclusion: Our data demonstrated that a PWL session does not increase systolic blood pressure up to the risk range and promotes PEH after 60 minutes of exercise and that this cardiovascular response persisted after 24 hours post-exertion in powerlifting athletes.

RBCCV 44205-847 Avaliação da intensidade de dor e da funcionalidade no pós-operatório recente de cirurgia cardíacaPain intensity and postoperative functional assessment after heart surgery Abstract Objective: To evaluate, in patients submitted to heart surgery, the intensity of pain and the level of functionality during the preoperative period, on the 7 th postoperative day and at hospital discharge. A secondary objective was to evaluate any possible relationship between pain and functionality taking into account the following variables: gender, age, first heart surgery or re-interventions, use of cardiopulmonary bypass (CPB), type of surgery and physiotherapeutic follow-up.Method: Forty-one patients who had undergone elective heart surgery at the Teaching Hospital of Botucatu/UNESP were studied. Pain intensity was measured using the VAS scale and functionality by the FIM scale (Functional Independence Measure) in the physical domain.Results: It was observed that the intensity of pain was higher on the 7 th postoperative day when compared with the preoperative period and at hospital discharge. No pain rating score was shown in the preoperative period, while a median pain intensity of 3 (moderate pain), was noted at hospital discharge. The highest levels of functional loss occurred on the 7 th postoperative day compared to the total scores obtained in the preoperative period and at hospital discharge. A significant correlation between pain and functionality was observed; a decrease in level of pain between the 7 th postoperative day and hospital discharge contributed to an increase in the functional levels.Conclusion: The evaluations performed in the BORGES, JBC ET AL -Pain intensity and postoperative functional assessment after heart surgery Braz J Cardiovasc Surg 2006; 21(4): 393-402

The greatest likelihood of developing kidney failure after heart surgery is observed when CPB is at least 90 minutes, although creatinine clearance was not significantly altered between the groups studied.

A 6-year-old female child sought medical service due to a gastrointestinal malformation. During medical follow-up, partial absence of the inferior vena cava was diagnosed, a rare congenital alteration affecting the vascular drainage from the inferior segment of the body. Imaging exams were accomplished, contributing to evaluation and description of the case. Conservative treatment with oral anticoagulant was maintained. The patient presents good evolution after long-term cardiovascular follow-up.

Fatores de risco pré-operatórios para o desenvolvimento de insuficiência renal aguda em cirurgia cardíacaPreoperative risk factors for the development of acute renal failure in cardiac surgery 34KOCHI, AC ET AL -Preoperative risk factors for the development of acute renal failure in cardiac surgery Braz J Cardiovasc Surg 2007; 22(1): 33-40