Endoscopic Surgery: Fit for Malignancy?

Neither experimental nor clinical data confirm the repeatedly published opinion that video-endoscopic surgery promotes tumor growth or the occurrence of implantation metastases in cancer patients. On the contrary, alterations due to pneumoperitoneum by the application of different gases, pressures, and temperatures might provide the basis for a new therapeutic approach to cancer surgery. Oncologically adequate resections defined by such terms as “no touch isolation” and “monobloc resection” can be performed video-endoscopically in a variety of intraabdominally or intrathoracically located cancers if a standardized technique is used. The benefit of video-endoscopic surgery is limited in large tumors, especially if they have reached the organ surface. There is still a major deficit in the clinical evaluation of video-endoscopic interventions in most oncologic diseases. Randomized studies comparing video-endoscopic and conventional surgery have been reported only for the resection of colorectal carcinoma. They show that laparoscopic resections can be performed with a minimum of postoperative complications to the same extent as conventional resections and offer several advantages during the early postoperative period. No reliable data from comparative trials are as yet available on the long-term results.     

Keep Fit简易锻炼法

“Keep Fit”已成为近代女性的新风气．你想健美就不容懒惰，必须每天进行锻炼。假如没有健身器材．也可以用其它东西代替．只要抱着Keep Fit的意向和信念．那么没有哑铃、没有举重器……都只不过是借口．因为生活上有许多可以信手拈来的物品能助你“Keep Fit”。例如：拿个空的塑胶瓶，装满清水便可作为模拟哑铃和举重器。再者，毛巾的作用只是洗脸和抹汗，它更能助你增强体质和臂力。还有又厚又硬的硬皮书，也是挺理想的器材。你抽空搜集齐这些工具．便可以让系列健身运动派上用场。在此给你介绍几种Keep Fit方法，想必对你会有所帮助!近年兴起玩高尔夫球，爱好此道者也不妨多练习手臂和手腕的力度．以及训练其灵活性。     

Fit für die Rettung?

Aim

Prospective examination of cardiovascular (CV) risk factors and cardiorespiratory fitness in firefighters (FFs) in Germany and comparison with the international literature.

Methods

A total of 97 North Rhine–Westphalian FFs working in emergency service participated in the study (time period 1/2014–9/2014). Participation was voluntary and data were anonymized. Anthropometric parameters, CV risk factors and cardiorespiratory fitness were examined. In order to estimate the 10-year CV risk, the Framingham Risk Score was utilized. The metabolic syndrome was diagnosed using the definition of the International Diabetes Federation.

Results

The examined FFs demonstrated a significant tendency towards obesity which was shown by the BMI and by abdominal waist circumference. In 32?% of FFs, an increased abdominal waist circumference was measured. Systolic resting blood pressure was elevated in 17.5?% of FFs; diastolic resting blood pressure was increased in 40.2?%. The relative maximal oxygen uptake (rel. VO_2max; 37.3 ± 6.3 ml ? kg^?1min^?1) was comparable with the average citizen. In international comparison, the 10-year CV risk can be seen as equivalent or less (according to the Framingham Risk Score). In 14?% of the examined FFs, a metabolic syndrome was detected. When regarding the metabolic syndrome, the international comparison revealed that the prevalence of the German FFs was among the lowest.

Conclusion

The results showed frequent CV risks factors in the examined FFs. Especially in a job which requires physical fitness, the results lead to a need for action in order to minimize the CV risk factors and to improve their fitness. Due to the particular labor conditions FFs have to be educated (empowerment). The setting has to be changed (internal training programs and leisure time activities toward more physical fitness) to decrease CV risk factors and to improve cardiorespiratory fitness. Therefore, an implementation of health-promoting concepts should be taken into consideration.

     

Hip joint replacement implant — Fit versus conformation

Summary We report the result of a preliminary anatomical study made to evaluate a new design for hip prosthesis, able to realize a good press-fit (positioning of an item by accommodation to the size and shape of a receptacle or space). Four proximal femora were obtained at autopsy and after the fixation, x-rays and photography, the specimen was ready for implantation. The “anatomical” prosthesis was implanted selecting from the available nineteen different sizes each for right and left side. Once the prosthesis was implanted, sections were taken at various levels in order to study the press-fit and conforming characteristics of the prosthesis. The fine detail radiography and histology studies of the specimen turned out to be very important: — the first underestimated inner cortical bone loss due to reaming; — the second was more accurate in assessment of cortical porosity in spite of the minimal degree of change noted. Cortical bone stock retention and profile outline parallelism confirmed that the implant provided a seating which followed the medullary cavity. The retention of trabecular bone in the proximal region provides the main stay of immediate interlock of implant with bone. This suggests a high probability of early healing and repair with bone ingrowth. The overall conformity of the implant to the original medullary cavity outline and the presence of the longitudinal and wide grooves in the implant strongly suggest a high probability of retention of vascularization in the inner portion of the cortex,. as well as opportunity for ingrowth during the healing process. These factors are good indicators of greater probability of enhanced healing.

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Résumé Les résultats d’une étude anatomique conduite pour évaluer un nouveau dessin prothétique capable de réaliser un bon press-fit (positionnement d’un modèle adaptable aux mesures et aux formes anatomiques du canal fémoral) sont présentés et discutés. Quatre fémurs prélevés sur des cadavres ont été photographiés et radiographiés, dans les quatre plans de l’espace et préparés pour l’implantation. La prothèse ≪ anatomique ≫ était implantée en tenant compte des 19 mesures différentes existantes de chaque c?té (de droite à gauche). Une fois la mise en place effectuée, des coupes histologiques correspondant aux sections faites aux différents niveaux ont été réalisées pour pouvoir étudier le press-fit et l’adaptabilité dans le canal fémoral, conformément aux caractéristiques de la prothèse. L’étude des détails radiologiques et histologiques s’est révélée d’une très grande importance, par le fait d’une perte tout à fait négligeable de la corticale interne par suite de l’alésage et d’une bonne stabilisation de la corticale en dépit de petits changements. La conservation du capital osseux cortical et le parallélisme entre os et prothèse, confirment que l’implant prothétique ainsi con?u favorise une parfaite adaptation à la forme de la cavité médullaire. La conservation de l’os trabéculaire dans la partie proximale métaphysaire permet une stabilisation immédiate de l’implant dans l’os qui devrait garantir une récupération clinique rapide grace à une repousse osseuse précoce. La conformation parfaite de l’implant à la cavité médullaire et la présence des cannelures le long de la queue de la prothèse font espérer une grande probabilité de très bonne revascularisation de la corticale interne et partant, une bonne repousse osseuse pendant la phase de consolidation. Ces facteurs laissent présager une amélioration de la guérison des patients.

     

Retropubic Versus Transobturator Midurethral Synthetic Slings: Does One Sling Fit All?

The purpose of this article is to evaluate the recent evidence base for the choice between transobturator and retropubic approaches to midurethral slings used to treat stress urinary incontinence. While the retropubic and transobturator approaches to midurethral sling surgery for stress urinary incontinence demonstrate equivalent efficacy across a number of randomized controlled trials, they do not appear to be equivalent when particular patient populations are considered separately. The retropubic approach appears to be a better option in patients with intrinsic sphincter deficiency and limited urethral mobility.     

Editorial Commentary: Knee Lateral Femoral Osteochondral Allografts Are Not Recommended for Medial Femoral Condylar Defects: If the Shoe Doesn’t Fit,Don’t Wear It!

Treatment of large articular cartilage defects of the knee is challenging, particularly in young, high-demand patients. Osteochondral allograft (OCA) transplantation is a viable treatment option, providing fully mature articular cartilage during a single operation while avoiding donor site morbidity. Indications are symptomatic, full-thickness articular cartilage defects >3 cm². Contraindications include a “kissing” lesion of the corresponding articular cartilage surface, uncorrected ligamentous instability, malalignment, peripheral osteophytes, joint-space narrowing, or absence of >50% of the meniscus in the affected compartment. Matching for size and contour is crucial; therefore, we use medial femoral condyle (MFC) allografts for MFC lesions and lateral femoral condyle (LFC) allografts for LFC lesions, and do not recommend LFC grafts for the MFC. Survival rates are 78.7% and 72.8% at 10 and 15 years, respectively.     

Of Fracture Thresholds and Bone Mineral Density Reference Data: Does One Size Really Fit All?

Men who fracture have greater mean bone mineral density (BMD) than women who fracture, and to some this suggests that BMD fracture “thresholds” are greater in men than women, justifying use of a male BMD reference standard. Others disagree and argue that because BMD distribution in men is right-shifted (higher) compared with women, anything that occurs with equal probability for men and women will occur at a greater mean BMD in men. If the latter is true, it supports using a common (female) BMD reference standard. We directly tested this latter principle and, indirectly, the validity of using a constant BMD reference standard, in 51,326 women (3722 major fractures) and 4691 men (276 fractures), by comparing mean BMD in fracture vs nonfracture groups defined by sex, age, race and body mass index because these 4 factors affect both mean BMD and risk of fractures. Among those who fractured, mean BMD for all measurement sites were significantly greater in men vs women, youngest vs oldest, whites vs Asian, and heaviest vs the lightest (all p < 0.001). However, the same BMD pattern was seen in those who did not fracture and the absolute difference in BMD between those who fractured and those who did not was essentially constant regardless of sex, age, race, or weight class (all p-interaction nonsignificant). This finding suggests that use of a common reference standard for BMD (i.e., young white women) for men, and indeed all subgroups defined by osteoporosis risk factors, is reasonable and consistent with empiric observations.     

Information for Authors

1 General Asian Journal of Andrology (AJA) is the official publication of the Asian Society of Andrology sponsored by the Shanghai Institute of Materia Medica, Chinese Academy of Sciences. The Journal has been included in 11 international indexing systems, including BIOSIS, CAB Abstracts, CAB Health, Chemical Abstracts, Current Contents/ Clinical Medicine, EMBASE, Index Medicus, MEDLINE, PASCAL, Research Alert, and SCI Expanded. The Impact Factor is 0.827 and ranks third among the international andrology journals.     

Information for Authors

1 General Asian Journal of Andrology (AJA) is the official publication of the Asian Society of Andrology sponsored by the Shanghai Institute of Materia Medica, Chinese Academy of Sciences. The Journal invites concise reports of original research on all areas of andrology, both experimental and clinical, including modern, traditional and epidemiological, from any pan of the world. Review articles will be     

Information for Authors

1 General Asian Journal ofAndrology (AJA) is the official publication of the Asian Society of Andrology sponsored by the Shanghai Institute of Materia Medica,Chinese Academy of Sciences.The Journal has been included in 11 international indexing systems,including BIOSIS,CAB Abstracts,CAB Health,Chemical Abstracts,Current Contents/