The effects of strength training, cardiovascular training and their combination on flexibility of inactive older adults

The purpose of this study was to investigate the effects of aerobic training, strength training and their combination on joint range of motion of inactive older individuals. Thirty-two inactive older men (65 - 78 yr) were assigned to one of four groups (n = 8 per group): control (C), strength training (ST), cardiovascular training (CT), and combination of strength and aerobic training (SA). Subjects in the S, A, and SA trained three times a week for 16 weeks. ST included 10 resistance exercises for the major muscle groups at an intensity of 55 - 80% of 1-RM and CT included walking/jogging at 50 - 80 % of maximal heart rate. Body weight and height, physical activity level and maximal oxygen uptake (.VO(2)max) were measured before the training period. Isokinetic (60 and 180 deg x sec(-1)) and concentric strength (1-RM in bench and leg press) were assessed prior to and at the end of the training period. Hip flexion, extension, abduction, and adduction, shoulder extension, flexion, and adduction, knee flexion, elbow flexion and sit-and-reach score were determined before and at 8 and 16 weeks of training. There were no differences between groups in .VO(2)max, body weight, and height (p < 0.05). ST and SA but not CT and C increased isokinetic and concentric strength at the end of the training period (p < 0.05). ST and SA increased significantly (p < 0.05) sit-and-reach performance, elbow flexion, knee flexion, shoulder flexion and extension and hip flexion and extension both at mid- and post-training. CT increased (p < 0.05) only hip flexion and extension at post training. Results indicate that resistance training may be able to increase range of motion of a number of joints of inactive older individuals possibly due to an improvement in muscle strength.     

The role of epidural spinal cord stimulation in the treatment of Buerger's disease

PURPOSE: This clinical, retrospective study is evaluated the effect of epidural spinal cord stimulation (SCS) in the treatment of Buerger's disease. METHODS: The clinical criteria of Shionoya were used to diagnose 29 patients (22 men, 7 women; mean age 33.7 years) with Buerger's disease. The patients underwent SCS. Complete physical examination and vascular laboratory data were available and recorded for all patients. Questions regarding the improvement of symptoms, in lifestyle, and in physical activities were asked direct interview or by telephone during mean follow-up of 4 years. RESULTS: The regional perfusion index (RPI), the ratio between the foot and chest transcutaneous oxygen pressure at baseline (before SCS treatment) was 0.27 +/- 0.25. Three months after SCS implantation the RPI increased to 0.41 +/- 0.22. During the follow-up period, a sustained improvement in microcirculation was recorded: the RPI at 1-year follow-up was 0.49 +/- 0.34 and at 3-year follow-up was 0.52 +/- 0.21. The most pronounced improvement in the RPI values was found in the subgroup of 13 patients with trophic lesions. In this group, the RPI increased significantly from 0.17 +/- 0.21 to 0.4 +/- 0.18 (P < .023) after a mean follow-up of 5.7 years. Two patients underwent major amputation of the lower target limb. The limb survival rate was 93.1%. During the follow-up period of 4 years, 21 of the 29 patients continued to smoke, and only five patients stopped nicotine exposure. CONCLUSIONS: We recorded a significant benefit in the microcirculation, a good limb survival rate, and the absence of new trophic lesions. During the follow-up period, no severe complications related to the implanted devices occurred. Because of the diffuse, distal, segmental nature of the disease, SCS should be considered as an alternative treatment modality in patients with Buerger's disease.     

Arthroscopic debridement of the osteoarthritic knee under local anaesthesia

This prospective study compared the efficacy of arthroscopic debridement in osteoarthritic knees under local, general or peridural anaesthesia. Between 1997 and 2001, 201 arthroscopic debridements were performed in 197 patients (173 partial meniscectomies, 192 articular trimmings, 119 microfractures, 201 lavage procedures) in 197 patients. Patients were treated under local (Group "L", n = 67), general (Group "G", n = 65) or peridural anesthesia ( Group "P", n = 65). No tourniquet was used. The follow-up ranged from 24 to 72 months (mean: 32 months). No major complication was noted. Results were assessed according to the scale of Baumgaertner et al independently from the type of anaesthesia used (p = 0.71). Results were excellent in 85 cases (L: 30, G: 27, E: 28), good in 75 (L: 25, G: 24, E: 26), fair in 27 (L: 9, G: 8, E: 10), poor in 14 (L: 7, G: 4, E: 3). Arthroscopic debridement of the osteoarthritic knee under local anaesthesia appears as an efficient, simple, safe, painless and cost-effective method of treatment.     

Patellar resurfacing as a second stage procedure for persistent anterior knee pain after primary total knee arthroplasty

Purpose

Knee pain after total knee arthroplasty may be caused by an unresurfaced patella. Secondary isolated resurfacing of the previously unresurfaced patella in total knee arthroplasty remains controversial. The aim of this retrospective study was to evaluate the outcome after patellar resurfacing as a second stage procedure.

Methods

The study included 22 patients (13 female/nine male) who underwent resurfacing of the patella with a mean follow-up of 61.8 ± 39.2 months. The mean age of the patients was 60 ± 9.7 years at the time of operation. The average period between total knee arthroplasty and patellar resurfacing was 26.3 ± 15.2 months. The patient’s subjective satisfaction was assessed by a custom-made questionnaire.

Results

The mean Knee Society Score improved significantly from 60.1 ± 8.3 to 77.0 ± 6.3 (p = 0.0063). The mean functional score also improved significantly from 42.7 ± 2.3 to 60.2 ± 3.9 (p = 0.001). Three patients (13.6%) needed further operative revision.

Conclusions

Although clinical scores showed significant improvement some patients continued to have pain and remained dissatisfied without detecting a specific reason. Further studies are needed to better elucidate the benefit of patellar resurfacing as second stage procedure.     

Genetics of chronic obstructive pulmonary disease, beyond a1-antitrypsin deficiency

It is known that only 10-20% of smokers develop COPD, implying that apart from environmental features, additional factors such as genetic variability contribute to smoke susceptibility. This proposal is in compatibility with the "Dutch Hypothesis", formulated in the early 60's. Alpha-1-antitrypsin gene was implicated in the pathogenesis of COPD, especially the homozygous state of z allele. Since then many other genes have stepped forward as possible contributors to COPD development. In the present review we attempt to summarize the majority of these, including the genes of matrix metalloproteinases and their inhibitors, elastin, serpine2, tumor necrosis factor - a, transforming growth factor beta, a variety of interleukins and their receptors and antagonists, high affinity IgE receptor , human calcium-activated chloride channel 1, heme oxygenase, vascular endothelial growth factor, microsomal epoxide hydrolase, glutathione S-transferase, cytochrome P45O, superoxide dismutase, vitamin D binding protein, beta2-adrenergic receptor, Toll like receptor, human B defensins, mucins, cystic fibrosis transmembrane regulator, surfactant protein and Nuclear Factor E2 Related Factor 2.     

Prediction of lithium response.

Even though lithium has been established as an effective agent in the management of primary affective disorders, not all manic-depressive patients respond favourably to lithium therapy. Therefore we attempted to delineate lithium responders from non-responders in a group of 54 manic-depressive patients on the basis of an assessment which included 64 variables and the results showed that only two thirds were pure responders. Females, patients with prior manic episodes, onset of the illness initially with a manic episode, and premorbid psychothymic personality were all indicators of favourable long-term lithium response. Patients with retarded depression, severe anxiety, though disorder and those with higher scores on the Psychopathic Deviate and Paranoia scales of the MMPI were poor lithium responders. It should be noted, however, that only a few of the differences between responders and non-responders were statistically significant. Our study suggests a number of predictive variables for the identification of lithium responders.     

Highly conforming polyethylene inlays reduce the in vivo variability of knee joint kinematics after total knee arthroplasty

The use of highly conforming polyethylene inlays in total knee arthroplasty (TKA) provides improved anteroposterior stability. The aim of this fluoroscopic study was to investigate the in vivo kinematics during unloaded and loaded active extension with a highly conforming inlay and a flat inlay after cruciate retaining (CR) total knee arthroplasty (TKA). Thirty one patients (50 knees) received a fixed-bearing cruciate retaining total knee arthroplasty (Genesis II, Smith & Nephew, Schenefeld, Germany) for primary knee osteoarthritis. Twenty two of them received a flat polyethylene inlay (PE), nine a deep dished PE and 19 were in the control group (physiological knees). The mean age at the time of surgery was 62 years. Dynamic examination with fluoroscopy was performed to assess the "patella tendon angle" in relation to the knee flexion angle (measure of anteroposterior translation) and the "kinematic index" (measure of reproducibility). Fluoroscopy was performed under active extension and flexion, during unloaded movement, and under full weight bearing, simulated by step climbing. No significant difference was observed between both types of polyethylene inlay designs and the physiological knee during unloaded movement. Anteroposterior (AP) instability was found during weight-bearing movement. The deep-dish inlay resulted in lower AP translation and a non-physiological rollback. Neither inlay types could restore physiological kinematics of the knee. Despite the fact that deep dished inlays reduce the AP translation, centralisation of contact pressure results in non-physiological rollback. The influence of kinematic pattern variability on clinical results warrants further investigation.