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literature.[1] Another noteworthy fact is that both
2. Jimenez-Jimenez FJ, Puertas I, de Toledo-
of our patients were young females, which
Heras M. Drug-induced myoclonus: Frequency,
is in contrast to previous literature.[2,3] Even
the previous case report of myoclonus with
quetiapine has been reported in an elderly
induced myoclonus. Int Clin Psychopharmacol
male.[3] However, the patient was also receiving
citalopram. We could Þ nd only one other case
4. Strachan PM, Benoff BA. Mental status change,
report where myoclonus has been reported with
myoclonus, electrocardiographic changes, and
acute respiratory distress syndrome induced by quetiapine overdose. Pharmacotherapy
It could be argued that the previous history
of seizures in our first case and history of
5. Goldstein JM. Quetiapine fumarate (Seroquel):
myoclonus on another antipsychotic may have
A new atypical antipsychotic. Drugs Today
predisposed the patient to the quetiapine-
induced EEG changes, and that the myoclonic jerks were part of a seizure disorder. Regarding the pathophysiology of these jerks, the action
CERVICAL STIMULATION FOR
of quetiapine on multiple neurotransmitters
VOLUMETRIC REDUCTION OF
may be involved, especially on serotonin and
LIMBS IN THE TREATMENT OF LYMPHEDEMA
Our cases highlight the need for careful
monitoring of patients on quetiapine, especially
Godoy and Godoy describe in this study a new
those with prior history of seizures or of any
lymph drainage technique which is different
from those previously described. It can be performed in isolation, as in cases of the face,
ASHISH AGGARWAL, R. C. JILOHA
or in conjunction with body lymph drainage.
Department of Psychiatry, G.B. Pant Hospital,
The technique is extremely simple and, with
due care, we believe the method is easily
Correspondence:
Fifteen female and three male patients with
REFERENCES
age of 57.8 years with grade II lymphedema of lower limbs in its initial phase (within three
1. Amann BL, Pogarell O, Mergl R, Juckel G, Grunze
to four months of onset as reported by the
H, Mulert C, et al. EEG abnormalities associated
patient) were selected over a two-year period.
with antipsychotics: A comparison of quetiapine,
Grade I lymphedema is deÞ ned as lymphedema
olanzapine, haloperidol and healthy subjects.
that evolves during the day with patients
having no signs of the disease after a night’s
Indian J Med Sci, Vol. 62, No. 10, October 2008
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rest. With Grade II lymphedema, the patient
the volume of limbs affected by lymphedema.
awakens with swelling of the limbs.[3] Diagnosis
In our opinion this is the first time that this
of lymphedema was clinical, confirmed by
has been reported, as there are no published
studies evaluating this approach. Thus, this is a new concept based on physical stimulation that
All patients were submitted to twenty-minute
utilizes light (almost tickling) digital movements.
daily sessions of cervical stimulation for five consecutive days. Stimulation of the
This finding raises a series of hypotheses
cervical region uses very light movements
to explain the effect of stimulation with the
(almost tickling) of the fingers or thumbs
authors suggesting a possible interference
without exerting pressure, as shown in Þ gure
in the contractions of lymphangions of the
1.(2) Approximately 40 to 60 stimuli were
lymphatic system via neurological stimuli and
employed per minute. The limb was evaluated
thus adding a probable synergic effect to
by volumetry, using the water displacement
technique, before and after the treatment
located in the space between two valves of the
program. For statistical analysis, the paired
vessels and constitute a contractile unit similar
student t-test was utilized with an alpha error
to the heart with their own beats and stimuli.
of 5% considered acceptable (P-value < 0.05). The research was approved by the Research
The Þ ndings of this study reinforce this hypothesis;
Ethics Committee of the Medical School in São
stimulation of determined regions of the body,
Jose do Rio Preto, Brazil and patient consent
in this case the cervical region, can trigger
responses at a distance, here presumably stimulating contractions of the lymphangions of
Statistically signiÞ cant volumetric reductions
were detected for all limbs (P-value = 0.0003), with an average reduction of 138.6 grams.
To conclude, the aim of this study was only to prove that stimulation reduces the size
of edematous legs and this objective was
technique of cervical region stimulation reduces
achieved. Hence we need to attempt to identify the mechanism that causes this effect.
JOSÉ MARIA PEREIRA DE GODOY, SILVIA HELENA SILVA1, MARIA CRISTINA TONINATO2, MARIA DE FÁTIMA GUERREIRO GODOY3
Livre Docente of the Cardiology and Cardiovascular
Surgery Department of the Medical School in São José
do Rio Preto (FAMERP), Professor of the Graduation
and post graduation courses of FAMERP and CNPq
1Physiotherapist, Student of Post Graduation the
Medical School, São José do Rio Preto-SP-FAMERP,
2Physiotherapist, student of the Latu Sensu Lymphedema
Figure 1: Cervical region stimulation
rehabilitation post graduation course - FAMERP,
Indian J Med Sci, Vol. 62, No. 10, October 2008
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3Occupational therapist, professor of the Lato sensu
of cervical stimulation in the reduction of edema
Lymphedema rehabilitation post graduation course of
of the face after cancer treatment. Q J Med
Medical School, São José do Rio Preto-SP-FAMERP
Correspondence:
2. Godoy and Godoy technique of cervical stimulation
Rua Floriano Peixoto, 2950, São Jose do Rio Preto-SP-Brazil
Zipe code: 15020-010, Tel/fax: 55 17 32326362
for lymphatic drainage. Available from: http://www.
drenagemlinfatica.com.br. 11th September 2008. REFERENCES
3. Board J, Harlow W. Lymphoedema 2: ClassiÞ cation,
signs, symptoms and diagnosis. Br J Nurs
1. Godoy JM, Godoy MF. Godoy and Godoy technique
Indian J Med Sci, Vol. 62, No. 10, October 2008
PHARMACEUTICAL COUNCIL OF WESTERN AUSTRALIAPre-Registration Training Plan for the First Segment - Months 1 to 3Objective: To ensure the competencies are achieved by each Graduate Trainee Pharmacist with consistent experience gained by all. Orientation and discussion of time allocation and prioritisation of tasks with preceptorFamiliarise with cash register policies and credit facilities availa
Implementing the Medical Home Model in Minnesota: A Case Study Prepared by a Joint Committee of the Association of Teachers of Maternal and Child Health (ATMCH) and the Association of Maternal and Child Health Programs (AMCHP) Supported by the Maternal and Child Health Bureau, HRSA February 2008 Table of Contents Introduction and Use of the Guide.…………
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