ABSTRACT
The study aimed to determine differences in sagittal-plane joint biomechanics between athletes with and without knee osteoarthritis (OA) during drop vertical jump 2 years after anterior cruciate ligament reconstruction (ACLR). Forty-one athletes with ACLR completed motion analysis testing during drop vertical jump from 30 cm. Sagittal-plane peak joint angles and moments and joint contributions to total support moment (TSM) were calculated during first landing. Medial compartment knee OA of the reconstructed knee was evaluated using Kellgren-Lawrence scores (ACLR group: Kellgren-Lawrence <2; ACLR-OA group: Kellgren-Lawrence ≥2). The ACLR-OA group (n = 13) had higher hip and lower knee contributions in the surgical limb than the ACLR group and their nonsurgical limb. Further, the ACLR-OA group had higher peak hip extension moment than the ACLR group (P = .024). The ACLR-OA group had significantly lower peak knee extension and ankle plantar flexion moments and TSM (P ≤ .032) than ACLR group. The ACLR-OA group landed with increased hip extension moment, decreased knee extension and ankle plantar flexion moments and TSM, and decreased knee and increased hip contributions to TSM compared with ACLR group. The ACLR-OA group may have adopted movement patterns to decrease knee load and compensated by shifting the load to the hip. Clinicians may incorporate tailored rehabilitation programs that mitigate the decreased knee load to minimize the risk of knee OA after ACLR.
ABSTRACT
BACKGROUND: Patients with anterior cruciate ligament reconstruction (ACLR) demonstrate lower knee loading. This study aimed to determine whether sagittal plane TSM and joint contributions to total support moment (TSM) in the surgical limb are different between athletes who did and did not show radiological features of knee OA at 2 years after ACLR during triple hops (TH), single hop (TH), single-legged vertical jump (VJ), and walking. METHODS: Forty-one athletes with 2 years of unilateral ACLR surgery participated in this cross-sectional study. Athletes completed motion analysis testing of single-legged TH, SH, VJ, and walking tasks. Sagittal plane TSM and individual joint (ankle, knee, and hip) contributions to TSM were computed at peak knee flexion angle (TSM-PKF). Posterior-anterior radiographs were completed in standing and 30° knee flexion. Kellgren-Lawrence (KL) system was used to identify radiological features of knee OA in the medial compartment of the reconstructed knee (OA-group: KL ≥2; Non-OA group: KL<2). RESULTS: There was a significant group-by-joint-by-task interaction for joint contributions to TSM-PKF (p = 0.012), with the OA-group (n = 13) had lower knee and higher hip contributions compared to the non-OA group during TH, SH, and VJ (p ≤ 0.049). There was a significant joint-by-group interaction for the joint contributions to TSM-PKF (p = 0.004), with the OA-group having lower knee (p = 0.003) and higher hip (p = 0.001) contributions compared to the Non-OA group. SIGNIFICANCE: The OA-group exhibited lower knee and higher hip contributions to the sagittal plane TSM compared to the Non-OA group during the landing phase of single-limb high-demand activities. The OA-group exhibited decreased knee loading and compensated by shifting the mechanical load to the hip joint within the reconstructed knee. Decreased knee loading in the OA-group may have affected the required mechanical loading to maintain knee metabolism and integrity.
Subject(s)
Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament Reconstruction , Osteoarthritis, Knee , Humans , Osteoarthritis, Knee/surgery , Cross-Sectional Studies , Anterior Cruciate Ligament Injuries/surgery , Biomechanical Phenomena , Knee Joint/surgeryABSTRACT
CONTEXT: Hip muscle strength and hop performance limb symmetries after anterior cruciate ligament reconstruction (ACLR) are not well studied. This study aimed to determine the differences in hip abductors' (ABD) and external rotators' (ER) muscle strength measures between limbs, and the relationship between hip ABD and ER muscle strengths and hop performance limb symmetry indices (LSIs) 2 years after ACLR. DESIGN: Cross-sectional study. METHODS: Forty (level I/II) men athletes 2 years after unilateral ACLR completed 4 single-legged hop tests and involved hip ABD and ER strength testing (maximum voluntary isometric contraction [MVIC]; isokinetic peak torque [PKTQ] at 60°, 180°, and 300°/s; and isotonic peak velocity at 75% of their MVICs). Muscle strength measures were normalized to body mass, and hop performances were reported as LSIs. Paired t test was used to determine strength differences between limbs, and the Pearson correlation coefficient was used to assess the relationship between involved hip muscle strength measures and hop performance LSIs. RESULTS: Hip ER-MVIC (involved: 60.26 [12.01], uninvolved: 63.68 [13.17] N·m/kg) and ER eccentric PKTQ at 60°/s (involved: 32.59 [9.28]; uninvolved: 35.73 [10.50] N·m/kg) were significantly different between limbs (P ≤ .018). Single-hop LSI correlated with hip ER-PKTQ at 180°/s (r = .354) and 300°/s (r = .324, P ≤ .041), while triple-hop LSI correlated with hip ER-MVIC (r = .320), concentric ER-PKTQ at 180°/s (r = .355), eccentric ER-PKTQ at 60°/s (r = .314), and hip ABD-PKTQ at 60°/s (r = .364) and 300°/s (r = .336, P ≤ .049). CONCLUSIONS: Men athletes demonstrated symmetrical hop performance and hip muscle strengths, except for ER hip's MVIC and isokinetic eccentric peak torque at 60°/s 2 years after ACLR. Hop performance LSIs had a few, yet positive moderate relationships with involved hip ABDs and ER strength measures. This may indicate that hip ABD and ER muscle strength measures contribute to athletes' hop performances 2 years after ACLR. Post-ACLR rehabilitation programs might incorporate hip muscle strengthening training to improve athletes' functional performances.
Subject(s)
Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament Reconstruction , Male , Humans , Quadriceps Muscle/physiology , Cross-Sectional Studies , Return to Sport , Anterior Cruciate Ligament Injuries/surgery , Athletes , Anterior Cruciate Ligament Reconstruction/rehabilitation , Muscle StrengthABSTRACT
The International Knee Documentation Committee Subjective Knee Form (IKDC2000) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) are knee-specific measures. However, their association with a return to sports after anterior cruciate ligament reconstruction (ACLR) is unknown. This study aimed to investigate the association between the IKDC2000 and the KOOS subscales and the return to the same pre-injury level of sport two years after ACLR. Forty athletes that were two years post-ACLR participated in this study. Athletes provided demographic information, filled out the IKDC2000 and KOOS subscales, and indicated whether they returned to any sport and whether they returned to the same pre-injury level (same duration, intensity, and frequency). In this study, 29 (72.5%) athletes returned to play any sport and eight (20%) returned to the same pre-injury level. The IKDC2000 (r: 0.306, p = 0.041) and KOOS quality of life (KOOS-QOL) (r: 0.294, p = 0.046) significantly correlated with the return to any sport, but it was age (r: -0.364, p = 0.021), BMI (r: -0.342, p = 0.031), IKDC2000 (r: 0.447, p = 0.002), KOOS-pain (r: 0.317, p = 0.046), KOOS sport and recreation function (KOOS-sport/rec)(r: 0.371, p = 0.018), and KOOS QOL (r: 0.580, p > 0.001) that significantly correlated with a return to the same pre-injury level. High KOOS-QOL and IKDC2000 scores were associated with returning to any sport, and high KOOS-pain, KOOS-sport/rec, KOOS-QOL, and IKDC2000 scores were all associated with returning to the same pre-injury level of sport.
ABSTRACT
BACKGROUND: Israeli physicians are very familiar with the problem of interruptions during encounters with patients. However, a thorough search of the medical literature revealed only one report of this problem from Israel, and none from other countries. OBJECTIVES: To characterize the phenomenon of interruptions to the patient-physician encounter in a clinic in Dimona and to assess the effect of an intervention program designed to reduce the magnitude of this problem. METHODS: During an 8 day work period in March 1997 all patient-physician encounters were recorded and characterized. An intervention program was then designed and implemented to reduce the number of interruptions. Data were again collected a year after the initial data collection. RESULTS: During the 8 day study period prior to the intervention program there were 528 interruptions to 379 encounters (mean of 1.39 per encounter). The main causes of interruptions were entrance of uninvited patients to the examination room (31%) and telephone calls (27%). Most of the interruptions occurred during the morning hours between 8 and 10 a.m. (45%) and at the beginning of the week (Sunday 30%). After the intervention program there were 402 interruptions to 355 encounters (mean of 1.13 per appointment, P = 0.21). CONCLUSIONS: There was no statistically significant improvement in the number of interruptions following the intervention program. This finding is either the result of a local cultural phenomenon, or it indicates a national primary care health system problem that may require a long-term educational program to resolve it. Further research is needed on the magnitude, causes and consequences of interruptions in family practice and, if warranted, methods will have to devised to cope with this serious problem.
Subject(s)
Physician-Patient Relations , Primary Health Care , Humans , Israel , Pilot Projects , Primary Health Care/organization & administration , Quality of Health Care , TelephoneABSTRACT
Epileptic patients given phenobarbital (3 mg/kg, n = 8) or finlepsin (20 mg/kg, n = 7) were found to have a statistically significant increase (p < 0.05) in the parameters of the lipid peroxidation end product malonic dialdehyde in the erythrocytes (3.34 +/- 1.13 mumol/liter) and blood plasma (0.099 +/- 0.04 mumol/liter) in comparison to the control group (n = 9; 1.58 +/- 0.96 mumol/liter and 0.045 +/- 0.02 mumol/liter, respectively). The urea level (6.7 +/- 1.28 mumol/liter) and the ammonia level (31.59 +/- 10.46 mumol/liter) increase were statistically insignificant as compared to the controls (5.76 +/- 0.66 mumol/liter and 26.41 +/- 5.96 mumol/liter, respectively). Bemitil (n = -7) in a dose of 20 mg/kg reduced in 10 days the amount of malonic dialdehyde in the erythrocytes (1.57 +/- 0.61 mumol/liter, p < 0.05) and plasma (0.043 +/- 0.02 mumol/liter, p < 0.05) as well as the amount of urea (3.76 +/- 0.96 mumol/liter,) and ammonia p < 0.05 and ammonia (18.17 +/- 2.02 mumol/liter, p < 0.05) in the blood. A favorable therapeutic effect (lesser frequency of seizures and lesser asthenia of the of the children) was observed at the same time. The frequency of paroxysms reduced to 50% in 4 patients (2 with complex-partial seizures, one with absence, and one with simple-partial seizures) and to 75-% in the fifth patient with complex-partial seizures. The therapeutic effect in the 6th and 7th patients could not be evaluated.
Subject(s)
Anticonvulsants/adverse effects , Benzimidazoles/adverse effects , Carbamazepine/adverse effects , Epilepsy/drug therapy , Lipid Peroxidation/drug effects , Nitrogen/metabolism , Phenobarbital/adverse effects , Administration, Oral , Adolescent , Ammonia/blood , Anticonvulsants/administration & dosage , Anticonvulsants/therapeutic use , Benzimidazoles/administration & dosage , Benzimidazoles/therapeutic use , Carbamazepine/administration & dosage , Carbamazepine/therapeutic use , Child , Child, Preschool , Epilepsy/metabolism , Erythrocytes/cytology , Erythrocytes/drug effects , Erythrocytes/metabolism , Female , Humans , Male , Malondialdehyde/blood , Phenobarbital/administration & dosage , Phenobarbital/therapeutic use , Treatment Outcome , Urea/bloodABSTRACT
To investigate the effect of ovarian steroids on the brain stem during changes of estrogen and progesterone blood levels, we recorded brain stem auditory evoked potentials with increased stimulus rates from 26 women treated for sterility by menotropins (Pergonal and Metrodin). These women were divided into three groups according to their estrogen and progesterone blood levels. The brain stem auditory evoked potential results revealed a significant delay of peak III only, with an increased stimulus rate in the group with the highest estrogen level. Estrogen may cause a brain stem synaptic impairment, presumably because of ischemic changes, and thus also may be responsible for a higher incidence of Bell's palsy during pregnancy.
Subject(s)
Evoked Potentials, Auditory, Brain Stem/drug effects , Facial Paralysis/chemically induced , Follicle Stimulating Hormone/pharmacology , Menotropins/pharmacology , Pregnancy Complications/chemically induced , Adult , Female , Follicle Stimulating Hormone/adverse effects , Follicle Stimulating Hormone/therapeutic use , Humans , Infertility, Female/drug therapy , Menotropins/adverse effects , Menotropins/therapeutic use , PregnancyABSTRACT
Experiments performed on male rats with chronically implanted electrochemotrodes showed bemitil (12.5 and 25.0 mg/kg, intra-abdominally, 24 h prior to the locus creation) suppresses he pathological activity of (100 ED) epileptogenic locus induced by he sodium salt of penicillin in the hippocampus of the animals. Probable mechanisms of antiepileptic action of bemitil are considered.
Subject(s)
Anticonvulsants/therapeutic use , Benzimidazoles/therapeutic use , Epilepsies, Partial/drug therapy , Hippocampus/drug effects , Animals , Anticonvulsants/pharmacology , Benzimidazoles/pharmacology , Convulsants , Depression, Chemical , Dose-Response Relationship, Drug , Drug Evaluation, Preclinical , Electrodes, Implanted , Electroencephalography/drug effects , Epilepsies, Partial/chemically induced , Epilepsies, Partial/physiopathology , Hippocampus/physiopathology , Injections, Intraperitoneal , Male , Penicillin G , RatsABSTRACT
Doppler flow studies of the intracranial internal carotid artery and middle cerebral artery performed in 17 women at 30-36 weeks of gestation, referred for evaluation of small for gestational age fetuses, resulted in abnormally low pulsatility index values (below 2 SD). These patients were investigated when fasting and 1 h after a 100-gram glucose load. Increase of 20 ml/dl or more was followed by elevation of the mean pulsatility index in the internal carotid artery from 1.03 +/- 0.09 to 1.44 +/- 0.22 (p < 0.001), and in the middle cerebral artery from 1.12 +/- 0.16 to 1.83 +/- 0.24 (p < 0.001). Pulsatility index values returned to normal (within 2 SD for gestational age) in 15 of the subjects investigated after glucose load. These findings suggest the importance of standard fasting state or determination of maternal plasma glucose levels in patients undergoing Doppler flow evaluation of growth-retarded fetuses.
Subject(s)
Blood Glucose/analysis , Cerebral Arteries/physiopathology , Fetal Growth Retardation/physiopathology , Ultrasonography, Doppler , Ultrasonography, Prenatal , Birth Weight , Blood Flow Velocity , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/embryology , Carotid Artery, Internal/physiopathology , Cerebral Arteries/diagnostic imaging , Cerebral Arteries/embryology , Embryonic and Fetal Development , Female , Fetal Growth Retardation/diagnostic imaging , Fetus/blood supply , Gestational Age , Humans , Maternal Age , PregnancySubject(s)
Blood Vessels/physiopathology , Chylothorax/surgery , Fetal Diseases/surgery , Fetal Heart/physiopathology , Adult , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/physiopathology , Blood Vessels/diagnostic imaging , Cardiac Output/physiology , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/physiopathology , Chylothorax/diagnostic imaging , Chylothorax/physiopathology , Drainage , Female , Fetal Diseases/diagnostic imaging , Fetal Diseases/physiopathology , Fetal Heart/diagnostic imaging , Hemodynamics , Humans , Infant, Newborn , Male , Pleural Effusion/diagnostic imaging , Pleural Effusion/physiopathology , Pleural Effusion/surgery , Pregnancy , Stroke Volume/physiology , Thoracostomy , Ultrasonography, Prenatal , Umbilical Arteries/diagnostic imaging , Umbilical Arteries/physiopathology , Umbilical Veins/diagnostic imaging , Umbilical Veins/physiopathology , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/physiopathologySubject(s)
Karyotyping , Ultrasonography, Prenatal , Female , Fetal Diseases/diagnosis , Humans , PregnancyABSTRACT
In 37 consecutive twin pregnancies, monthly Doppler sonographic measurements were made of blood flow velocity waveforms of the internal carotid and umbilical artery of each fetus. A total of 197 Doppler studies were performed. Of the 74 infants, 23 were small for gestational age (SGA). Thirty-five of the SGA Doppler studies were abnormal, giving an overall sensitivity for predicting SGA fetus of 58% and a positive predictive value of 71%. These data are not as sensitive and specific as our earlier data; however, Doppler criteria preceded sonographic diagnosis of SGA by a mean interval of 3.7 weeks and demonstrated better sensitivity and specificity. A combination of these parameters improves sensitivity to 84%. We conclude that Doppler velocimetry complements real-time ultrasonography for the early diagnosis of abnormal growth in twin pregnancies.
Subject(s)
Carotid Artery, Internal/diagnostic imaging , Pregnancy, Multiple , Ultrasonography, Prenatal , Umbilical Arteries/diagnostic imaging , Blood Flow Velocity , Carotid Artery, Internal/physiology , Female , Fetal Growth Retardation/diagnostic imaging , Fetal Growth Retardation/physiopathology , Humans , Pregnancy , Pregnancy, Multiple/physiology , Prospective Studies , Sensitivity and Specificity , Twins , Umbilical Arteries/physiologyABSTRACT
A microcomputer-based system has been developed that continuously analyzes the fetal electrocardiogram (ECG) and Doppler cardiogram during labor by noninvasive means. Three systolic time intervals (preejection period [PEP], ventricular ejection time [VET], and isovolumetric contraction time), and four ECG parameters (P-R interval, QRS wave duration, T/QRS amplitude ratio, and S-T slope) are simultaneously measured and displayed. Normal values were derived from 126 uncomplicated pregnancies at term. A second group of 89 cases showing fetal heart rate patterns suggestive of fetal distress were subsequently studied: 64 had a good outcome (umbilical artery pH 7.20 or higher and a 5-minute Apgar score 7 or greater) and 25 were asphyxiated. Results were retrospectively analyzed. All asphyxiated fetuses had preejection period, PEP to VET ratio and T to QRS ratio values of more than 1 SD above the mean for the normal population. The PEP to VET ratio, which is an indicator of myocardial function independent of heart rate, proved to be the most sensitive predictor of fetal asphyxia. We conclude that analysis of systolic time intervals and ECG parameters of the fetal heart during labor improves the diagnostic accuracy of fetal heart rate monitoring.
Subject(s)
Electrocardiography , Fetal Distress/physiopathology , Fetal Monitoring/methods , Heart Rate, Fetal/physiology , Systole/physiology , Adult , False Negative Reactions , False Positive Reactions , Female , Humans , Microcomputers , Predictive Value of Tests , Pregnancy , Pregnancy Outcome , Retrospective StudiesABSTRACT
This retrospective study represents our experience with cervical cerclage (suture) in pregnancies with uterine malformation. Seventeen patients with uterine malformations were involved. In these patients, the outcome of 31 gestations with cervical cerclage was evaluated. Uterine malformation was associated with cervical incompetence in 41% of the patients. Term delivery rate and fetal loss were observed in 56% and 26% of pregnancies, respectively. Infant salvage was not significantly different regardless of whether cervical incompetence was present or absent. A prolonged hospital stay and frequent use of tocolysis were noted during gestations with cerclage. Our data suggest that the outcome of pregnancies with uterine malformation was not improved by cervical cerclage when the indication for cerclage was the malformation itself.
Subject(s)
Cervix Uteri/surgery , Pregnancy Complications/surgery , Uterus/abnormalities , Adult , Female , Humans , Pregnancy , Pregnancy Outcome , Retrospective Studies , Tocolysis , Uterus/surgeryABSTRACT
OBJECTIVE: We conducted this cohort analytic study to determine whether women with unexplained elevations of maternal serum hCG at 16-20 weeks' gestation are at increased risk for pregnancy complications and adverse perinatal outcomes. METHODS: The inclusion criteria were a singleton gestation, a confirmed gestational age, and an hCG level greater than 2.5 multiples of the median (MOM). The exclusion criteria were fetal anomalies, an abnormal karyotype, and a maternal serum alpha-fetoprotein (MSAFP) level greater than 2.5 MOM. A group of randomly selected women with normal hCG and MSAFP levels served as controls. RESULTS: Of the 6011 women screened, 284 (4.7%) had an unexplained elevated hCG level. Patients with elevated levels of hCG had a significantly higher risk for hypertension (odds ratio 4.4; 95% confidence interval [CI] 1.9-10) and fetal growth restriction (odds ratio 2.8; 95% CI 1-7). Women with hCG levels greater than 4 MOM also had an increased risk of preterm delivery (odds ratio 3.3; 95% CI 1.3-8.2). CONCLUSION: Pregnancies with unexplained elevated hCG levels should be regarded as high-risk pregnancies and managed accordingly.
Subject(s)
Chorionic Gonadotropin/blood , Pregnancy Complications/blood , Female , Humans , Odds Ratio , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Outcome , Pregnancy Trimester, Second , Regression Analysis , Risk FactorsABSTRACT
A diagnosis of the Neu-Laxova syndrome (NLS) was made by ultrasonography at 32 wks of gestation. Ultrasonographic examination showed intrauterine growth retardation (IUGR), Dandy-Walker anomaly, choroid plexus cysts, receding forehead and microcephaly, bilateral cataract without prominent eyes, scalp edema with no generalized edema, retrognathia, curved penis, and flexion deformities of limbs. The findings in this case are consistent with NLS; however, they did not fit any of Curry's [1982] groups. Massive swelling of hands and feet were among the main manifestations in classic NLS cases. In the case presented herein, edema was noted only in the scalp. This might shed further light on the question of variability vs. heterogeneity in the NLS. This case shows the existing possibility of an early diagnosis of NLS and adds Dandy-Walker anomaly and choroid plexus cysts as new findings to this syndrome.
Subject(s)
Abnormalities, Multiple/diagnostic imaging , Fetal Growth Retardation/diagnostic imaging , Ultrasonography, Prenatal , Abnormalities, Multiple/pathology , Female , Fetal Growth Retardation/pathology , Humans , Pregnancy , SyndromeABSTRACT
Hair chromium concentration (HCC) of normal and diabetic pregnant women was determined by atomic-absorption spectroscopy. For nondiabetic pregnant women the value from 68 hair samples was 472 +/- 61 ng/g (mean +/- 95% CI); for gestational diabetics it was 734 +/- 155 ng/g from 42 hair samples. The difference was highly significant (P less than 0.005). Intermediate hair chromium concentrations were observed in 20 pregnant women with pregestational, overt diabetes mellitus (mean: 575 +/- 182 ng/g). Fifty-two women had a second hair sample taken later during pregnancy that showed a significant decrease in HCC (P less than 0.05). However, this decrease was confirmed only for the diabetic pregnant group. Age and parity did not influence the HCC. The data suggest that impaired utilization of chromium may be a possible etiology for gestational diabetes mellitus.