Pectoralis minor length measurements in three different scapula positions.

BACKGROUND: The pectoralis minor (PM) muscle is commonly regarded as a contributor to abnormal scapula positioning. Subsequently, the muscle length of the scapular stabilising muscles may be affected, as these muscles assume a lengthened position, which over time causes weakness. There are inconsistencies regarding PM muscle length values because of the different techniques and positions used when the length of the PM muscle is measured. OBJECTIVE: To determine the PM muscle length in participants aged 18-24 using a Vernier® caliper and expressed as pectoralis minor index (PMI), with the scapula in three different positions. METHOD: The PM muscle length of 144 participants was measured with a Vernier® caliper (intraclass correlation coefficient 0.83-0.87). Measurements were made with the scapula in the resting position, in an active and a passive posterior tilt position. RESULTS: Significant differences were observed in PMI between the resting scapula position - 10.04 (confidence interval, CI 9.93-10.14) and active posterior tilt - 10.19 (CI 10.09-10.30) (p < 0.001); the resting position - 10.04 (CI 9.93-10.14) and passive posterior tilt - 10.77 (10.66-10.87) (p < 0.001) and active - 10.19 (CI 10.09-10.30) and passive posterior tilt 10.77 (10.66-10.87) (p < 0.001). The dominant side had lower PMI values than the non-dominant side. CONCLUSION: The significant differences between the active and posterior tilt positions suggested that optimal muscle length of PM was affected by the inner range strength of the lower fibres of Trapezius. CLINICAL IMPLICATIONS: It is important that in clinical practice not only the length of PM in scapular misalignment but also the strength of the antagonistic muscles is considered.

[Cardiopulmonary exercise testing in chronic obstructive pulmonary disease (COPD) - breath-functional characterization and disease severity assessment]. / Spiroergometrie bei chronisch obstruktiver Lungenerkrankung (COPD) - atemfunktionelle Phänotypisierung und Schweregradbeurteilung.

COPD is a heterogeneous disease with a wide range of clinical phenotypes and breath-functional dysfunctions. Cardiopulmonary exercise testing (CPET) allows describing all component parts of breathing and determining exercise capacity and the mechanisms of exercise limitation. From these aspects 64 COPD patient stages II, III and IV according to the conventional GOLD classification were examined by means of CPET to evaluate whether CPET can provide a better functional characterization of COPD than the standard investigation procedures in pulmonary practice.We could show that in pulmonary practice CPET is safely and effectively practicable in stable COPD patients of all GOLD stages. This method allowed a clinical and prognostic disease severity assessment of all patients, proving important differences of peak oxygen uptake in each GOLD stage, so that patients in spite of identical GOLD disease severity were to be assigned to different prognostic groups according CPET criteria. Furthermore, we found relevant differences of individual breath-functional patterns in exercise, which can neither be objectified nor be prognosticated by standard investigation procedures at rest.Therefore CPET allows, aside from an objective clinical and prognostic disease severity assessment, also a breath-functional evaluation in a subtly way in COPD patients reflecting the multidimensional background of the disease with variable dysfunctions in pulmonary ventilation, gas exchange, circulation and muscular function as well as associated cardio vascular comorbidities. The breath-functional phenotyping of the COPD patient seems to be meaningful in particular for an individualised therapy management.

Late onset Takotsubo cardiomyopathy after mitral valve replacement.

We report a case of delayed onset Takotsubo cardiomyopathy (TC) in a 69-year-old woman, associated with minor stressors, two weeks after mitral valve replacement. After suffering several minor complications she had fully recovered and her discharge was planned. On the 14th postoperative day she had to be resuscitated due to cardiogenic shock. TC was diagnosed based on reduced ventricular function with apical ballooning and normal coronaries. Treatment with catecholamines and intra-aortic balloon pump led to full recovery. She continues to do well two years after surgery. TC should be considered as a potential cause of delayed ventricular dysfunction in postcardiac surgery patients.

A novel leucodystrophy in a dog.

A diffuse, bilaterally symmetrical leucoencephalopathy was observed in a 2-month-old female crossbred puppy with a clinical history of progressive tetraparesis with front limb hypermetria, head tremor and seizures. Severe myelinolytic lesions with significant macrophage infiltration were confined to the white matter, mainly of the cerebellum and spinal cord. Moderate loss of myelin with severe gliosis predominated in the cerebrum. Axonal degeneration and axonal loss accompanied myelin degeneration. This disease was classified as a leucodystrophy. The clinical signs and certain features of the lesions (morphology and distribution), differed from those in previously described degenerative myelinolytic diseases in animals. The possible occurrence of the disorder in a littermate suggested a genetic basis.