Single leg aerobic capacity and strength in individuals with surgically repaired anterior cruciate ligaments

ObjectivesCompare single-leg aerobic capacity and strength differences between the surgically repaired ACL leg (injured) and the uninjured leg.DesignCross-sectional study.SettingLaboratory.ParticipantsEight participants (5 female, 3 male, age = 23 ± 3.5 y, mass = 72.3 ± 17.3 kg, height = 169.7 ± 9.4 cm) that returned to play from ACL surgery between six and 18 months.Main outcome measuresParticipants performed an aerobically-based, single-leg cycling protocol to determine maximum oxygen consumption, ventilatory threshold, heart rate, rating of perceived exertion, and maximal watts cycled. Participants also performed isokinetic knee flexion and extension on a dynamometer to assess peak torque, total work, work fatigue, and power.ResultsThere were no statistical differences in single-leg aerobic capacity or strength outcomes between the injured and uninjured legs.ConclusionsIndividuals who have had an ACL surgically repaired six to 18 months after return to play do not appear to have aerobic capacity or strength deficits between the injured leg and uninjured leg.     

Direct cortical stimulation with cylindrical depth electrodes in the interhemispheric fissure for leg motor evoked potential monitoring

ObjectiveTo evaluate cylindrical depth electrodes in the interhemispheric fissure as an alternative to subdural strip electrodes for direct cortical stimulation (DCS) leg motor evoked potential (MEP) monitoring.MethodsA cylindrical depth electrode was positioned in the interhemispheric fissure of 37 patients who underwent supratentorial brain surgery. Leg sensory and motor cortices were localized by highest tibial nerve somatosensory evoked potential amplitude and lowest DCS leg MEP threshold; the lowest-threshold electrode was then used for DCS leg MEP monitoring.ResultsIntraoperative leg MEPs were obtained from all the patients in the series. The mean intensity applied for leg MEP monitoring with the cylindrical depth electrode was 15.2 ± 4.0 mA. No complications secondary to neurophysiological monitoring were detected.ConclusionsLower extremity MEPs were consistently recorded using a multi-contact cylindrical depth electrode in the interhemispheric fissure by DCS.SignificanceCylindrical depth electrodes may be a safe and effective alternative for DCS in the interhemispheric fissure, where subdural strips are difficult to place.     

First growth reference curves for Tunisian children and adolescents

A growth chart is a powerful graphical tool displaying children's growth patterns. The aim of this study was to develop growth reference curves appropriate for Tunisian children. The collection of data from this cross-sectional study was conducted on 4358 healthy subjects (2182 girls and 2176 boys) in three pediatric centers and 15 schools. Smoothed growth curves were estimated using the LMS method. The smoothed percentile curves for height, weight, sitting height (SH), and leg length (LL) increase rapidly during the 1st years of life and then progress slowly until 18 years. However, the sitting height-to-height ratio (SHTHR) curves decrease sharply before the age of 4 and then stabilize in both sexes. In addition, the comparison between boys and girls indicated that the values are very similar at most ages. Except during puberty, the values in boys increase (P < 0.0001) for the weight, height, SH, and LL parameters and decline (P < 0.0001) in the SHTHR compared to the values in girls. The growth rate curves presented two remarkable velocity peaks: the first appears during the 1st years of life and the second at puberty. Height gains at the last stage of growth (puberty) are around 15.45% of final height for boys and 15.52% for girls. This study showed a number of discrepancies for certain age groups when comparing the median weight and height values with those of the World Health Organization, the National Center for Health Statistics, and Algerian references in both sexes. Conclusion: The smoothed percentile curves for weight and height will be useful to access the general growth of Tunisian children. Furthermore, the SH, LL, and SHTHR curves can be used to monitor body proportions during childhood.     

Comparison of two different designs of forefoot off-loader shoes and their influence on gait and spinal posture

BackgroundThe purpose of forefoot off-loader shoes (FOS) is to unload the operated region of the foot in order to allow early mobilization and rehabilitation. However, little is known about the actual biomechanical effects of different designs of FOS on gait, pelvis and spine.Research questionAim of this study was to analyse and compare the effects of two different designs of forefoot unloader shoes.MethodsOrtho-Wedge (FOS A) and Relief-Dual® (FOS B) were evaluated in this study during standing and while walking. Changes of the pelvic position and spinal posture were measured with a surface topography system and an instrumented treadmill. Gait phases were detected automatically by a built-in pressure plate.ResultsBoth FOS resulted in a significant increase of pelvic obliquity, pelvic torsion, lateral deviation and surface rotation (p < 0.001) while standing. Between both shoe models, pelvic obliquity and lateral deviation (p < 0.05) were significantly different. During walking, both FOS had a significant effect on spine and pelvis (p < 0.05), however only minor differences were found between the designs. All gait parameters were affected more, wearing FOS A than B. Step length were significantly longer by wearing FOS (p < 0.005). However stance phase raised and swing phase is reduced on the leg wearing FOS A (p < 0.001).SignificanceThe study showed that FOS lead to significant changes in pelvic position and spinal posture during standing and while walking. A compensating shoe on the contralateral side is therefore recommend. Gait parameters however were affected more by the traditional FOS A half-shoe. The sole- design and shape of FOS B leads to a more physiological roll-over of the foot.     

Optimised gynaecological examination with a new pelvic examination chair

ObjectiveThe present aim was to contribute to improving the traditional pelvic examination chair with vertical leg support and to evaluate patients’ and examiners’ experience of a new gyneacological and urological examination chair with heated upholstery.Study designA new gynaecological and urological examination chair was constructed with laterally adjustable leg support, a foot-plate and the perineum exposed only during the examination procedure. Patients (n = 131) with or without endometriosis were invited to participate in an anonymous questionnaire survey concerning how they experienced a gynaecological examination.Main outcome measuresThe patients and the gynaecologists who performed the examinations answered questionnaires evaluating the examination procedure in the traditional and in the new gynaecological and urological examination chair, respectively. The questionnaires asked about comfort, heating, integrity and the experience of pelvic examination with vertical or lateral leg support. The examination times were measured with a stop-watch.ResultsThe majority of the answers (n = 131) were significantly (p < 0.05–0.001) in favour of the new concept with lateral leg support and with increased comfort and integrity. The average examination time was significantly shortened and the patients more relaxed in the new gynaecological and urological examination chair.ConclusionThe traditional gynaecological chair with vertical leg support has remained basically unchanged for many years. The present study showed that the pelvic examination procedure can be significantly optimized with easy patient-friendly adaptations.     

Effect of lower leg compression during cesarean section on post-spinal hypotension and neonatal hemodynamic parameters: nonrandomized controlled clinical trial

ObjectivesThis study aimed to determine the effect of lower leg compression during cesarean section (CS) on post-spinal hypotension (PSH) and neonatal hemodynamic parameters.MethodsThis study is a nonrandomized controlled clinical trial conducted in the cesarean delivery unit of the National Medical institute, Damanhour, Egypt. The sample included 120 parturients (60 intervention and 60 control). The researchers developed three tools for data collection: sociodemographic data and reproductive history interview schedule, electronic monitoring of maternal hemodynamic parameters, and neonatal hemodynamic assessment sheet. All parturients received ordinary pre-operative care. For the intervention group, a long elastic stocking (ordinary pressure 20–30 mmHg, 1 mmHg = 0.133 kPa) was applied on both legs during cesarean section. The control group received the same care without the elastic stocking.ResultsSystolic blood pressure, diastolic blood pressure, and mean arterial blood pressure were significantly higher in the intervention group throughout the entire operation period except in the last 5–15 min. Heart rate was significantly lower in the intervention group. Only 13.3% of the intervention group took ephedrine compared with 45% of the control group. Apgar score was higher among neonates of intervention group compared with the control group at 1 min. Neonatal acidosis was significantly higher in the control group than in the contral group.ConclusionLower leg compression technique can effectively reduce PSH and neonatal acidosis.     

Marjolin's Ulcer Presenting with In-Transit Metastases: A Case Report and Literature Review

Marjolin''s ulcer is an aggressive cutaneous malignancy common in previously traumatized or chronically inflamed skin. It has high regional metastasis and fatality rates. Our patient presented with subcutaneous nodules and ulcerations on the right limb. He had a history of osteomyelitis of the fifth toe. Histopathological examination of the nodule and ulceration demonstrated squamous cell carcinoma. The nodules and ulcerations were in-transit metastases of Marjolin''s ulcer. Here, we present a case of squamous cell carcinoma arising at a site of a chronic osteomyelitis with resultant in-transit metastases.     

Biomechanical compensation mechanisms during stair climbing – The effect of leg length inequalities

BackgroundStair climbing is a complex and demanding daily activity with increased physical loads. Therefore, analyzing stair climbing abilities is a frequently used diagnostic tool. Leg length inequalities (LLIs) are a common condition in the population, with individual consequences like lower back pain, scoliosis, and osteoarthritis. Despite its high prevalence, the necessary treatment, for mild LLIs, is still controversial. Previously, the focus was to analyze the effects of LLIs during static standing and walking. To create a holistic view on the dynamic effects of LLIs, and since climbing stairs produces a similar biomechanical imbalance as LLIs, the compensation mechanics during stair climbing are of special interest.Research questionWhat are the biomechanical compensation mechanisms of (simulated) LLIs during ascending and descending stairs?MethodsThirty-five healthy participants were measured with the inertial measurement system MyoMotion during stair climbing with simulated LLIs of 0–3 cm. The maximum estimated lower limb joint angles of the long and short leg were analyzed with statistically repeated measurement models.ResultsThe long leg showed significantly increased hip and knee flexion, while the short leg showed decreased hip and knee flexion, decreased dorsiflexion, and significantly increased plantarflexion. Different mechanisms were found in the case of 1 cm LLI when compared to greater LLIs. In the former, increased hip and knee flexion in the short leg accompanied by increased dorsiflexion in the long leg was observed. In the latter, the dorsiflexion of the long leg was reduced.SignificanceExcept for the reduced dorsiflexion of the long leg (LLI >1 cm), during stair climbing compared compensation mechanisms as during walking were presented, with the long leg functionally shortened and the short leg lengthened. Although the feet were already on different levels, during stair climbing with the step-over-step technique, significant compensation mechanisms were found as a consequence of LLIs.     

全膝关节置换术后下肢不同抬高度数对引流量的影响

目的：探讨全膝关节置换术后下肢不同抬高度对引流量的影响。方法将2013－2014年我院60例已经接受全膝关节置换术患者随机分为观察组和对照组各30例，观察组患者术后将下肢抬高60°，而对照组患者下肢抬高30°，观察两组患者术后伤口的引流量、切口愈合时间以及出院时的膝关节功能评分。结果术后2h、4h、12h、24h引流量，观察组平均分别为60mL、100mL、130mL、160mL，对照组平均分别为140mL、250mL、300mL、350mL，两组差异有统计学意义（P＜0．05），而两组患者的切口愈合情况与出院时膝关节功能评分差异无统计学意义（P＞0．05）。结论全膝关节置换术后抬高下肢60°能明显减少术后引流量，是一种有效的减少全膝关节置换术后失血的方法，但对患者的切口愈合时间以及出院的功能评分并无太大影响。