Minimally Invasive Total Knee Arthroplasty Improves Early Knee Strength But Not Functional Performance : A Randomized Controlled Trial

A prospective, randomized investigation compared early clinical outcomes of total knee arthroplasty (TKA) using conventional or minimally invasive surgical (MIS) approaches (n = 44). Outcome measures included isometric quadriceps and hamstrings strength, quadriceps activation, functional performance, knee pain, active knee range of motion, muscle mass, the Short Form-36, and Western Ontario and McMaster University Osteoarthritis Index, assessed preoperatively and 4 and 12 weeks after TKA. Four weeks after TKA, the MIS group had greater hamstring strength (P = .02) and quadriceps strength (P = .07), which did not translate to differences in other outcomes. At 12 weeks, there were no clinically meaningful differences between groups on any measure. Although MIS may lead to faster recovery of strength in patients undergoing TKA, there was no benefit on longer-term recovery of strength or functional performance.     

Not so FAST

BACKGROUND: Focused assessment with sonography for trauma (FAST) as a screening tool in the evaluation of blunt abdominal trauma will lead to underdiagnosis of abdominal injuries and may have an impact on treatment and outcome in trauma patients. METHODS: From October 2001 to June 2002, a protocol for evaluating hemodynamically stable trauma patients with suspected blunt abdominal injury (BAI) admitted to our institution was implemented using FAST examination as a screening tool for BAI and computed tomographic (CT) scanning of the abdomen and pelvis as a confirmatory test. At the completion of the secondary survey, patients underwent a four-view FAST examination (Sonosite, Bothell, WA) followed within 1 hour by an abdominal/pelvic CT scan. The FAST examination was considered positive if it demonstrated evidence of free intra-abdominal fluid. Clinical, laboratory, and imaging results were recorded at admission, and FAST examination results were compared with CT scan findings, noting the discordance. RESULTS: Patients with suspicion for BAI were evaluated according to protocol (n = 372). Thirteen cases were excluded for inadequate FAST examinations, leaving 359 patients for analysis. There were 313 true-negative FAST examinations, 16 true-positives, 22 false-negatives, and 8 false-positives. Using CT scanning as the confirmatory test for hemoperitoneum, FAST examination had a sensitivity of 42%, a specificity of 98%, a positive predictive value of 67%, a negative predictive value of 93%, and an accuracy of 92%; chi analysis showed significant discordance between FAST examination and CT scan (5.85%, < 0.001). Six patients with false-negative FAST examinations required laparotomy for intra-abdominal injuries; 16 patients required admission for nonoperative management of injury. Of the 313 true-negative FAST examinations, 19 patients were noted to have intra-abdominal injuries without hemoperitoneum and 11 patients were noted to have retroperitoneal injuries. CONCLUSION: Use of FAST examination as a screening tool for BAI in the hemodynamically stable trauma patient results in underdiagnosis of intra-abdominal injury. This may have an impact on treatment and outcome in trauma patients. Hemodynamically stable patients with suspected BAI should undergo routine CT scanning.     

Autologous Augmentation-Mastopexy After Bariatric Surgery: Waste Not Want Not!

Background  

The escalating trend in obesity is having major impact on health and the economy. As a result of NHS policies to reduce obesity, the number of patients losing weight following bariatric surgery is increasing rapidly. In addition to the systemic benefits to their general health, dramatic weight loss leads to marked changes in body habitus, with many patients seeking further “aesthetic” surgery to improve their appearance. We present our technique of autologous augmentation-mastopexy to address the problems of both skin excess and insufficient breast volume.     

Physiological fatigue of smooth muscle contractions in rat urinary bladder

OBJECTIVE: To characterize the physiological fatigue in bladder smooth muscles that can occur within 60 s of stimulation, which is closer to the duration of normal voiding. MATERIALS AND METHODS: Longitudinal and transverse strips of rat bladder were used; the muscles were mounted in an in vitro multi-muscle chamber, and the decline in contractile tension recorded during continuous electrical stimulation at frequencies of 5-30 Hz for 60 s. The effect of muscle length on fatigue was assessed by monitoring the decline in tension during 30 Hz stimulation at rest length, and at 60% and 100% stretched lengths of the bladder strips. To assess some of the factors involved in the development of fatigue, tension responses of fatigued muscles were monitored on exposure to 80 mm potassium or 1 microm bethanechol. RESULTS: In both longitudinal and transverse bladder strips stimulated at 30 Hz, peak contractile tension declined to 50% of original after approximately 33 s, and to 30% after 60 s of stimulation. After 10 s rest, 60% of the original tension was recovered. Increasing the frequency of fatigue stimulation from 5 to 30 Hz significantly increased the extent of the decline in tension and reduced the time to a 50% decrease in tension. Stretching the bladder strips from rest length to 100% stretched length significantly reduced the extent of tension decline and increased the time to a 50% decrease in tension. Exposure of fatigued muscles to high potassium or bethanechol generated more tension than electrical stimulation. CONCLUSION: Contractile fatigue occurs in both longitudinal and transverse strips of the bladder smooth muscles within the duration of normal voiding. Increasing the frequency of stimulation from 5 to 30 Hz increased the degree and rate of fatigue. Stretching the bladder strips from rest length by 60-100% reduced the degree and rate of fatigue. Bladder fatigue may be caused by decreased depolarization of the smooth muscle membranes, reduced release of acetylcholine from presynaptic nerve terminals, or by other yet undetermined mechanisms.     

ACCESSORY SOLEUS MUSCLE: A PROBLEM OF AWARENESS

Reports of accessory soleus muscle are rare, perhaps as a result of it often remaining unrecognized. It presents as a swelling behind the ankle and may be mistaken for a tumour or inflammatory lesion, as occurred in the first of a series of three cases. The other two were incidental findings, one in a 30 year old man with an open tibial fracture and the other in a 9 month old child with a club foot. Patients present with either pain or a diagnostic problem. When large, it may make wearing of footwear difficult. Computerized tomography with electromyography enables confirmation of the diagnosis. Pain is relieved by epimysiotomy and when encountered incidentally during surgery, incision of the epimysium is all that is needed. Excision of the muscle may be considered only if wearing of footwear is difficult. The significance of its presence in a case of club foot is unknown. Disinsertion of its insertion was all that was required to obtain surgical correction of the deformity in the present case. Awareness of the condition will prevent unnecessary surgery in asymptomatic cases.