Postoperative swelling after elbow surgery: influence of a negative pressure application in comparison to manual lymphatic drainage-a randomized controlled trial

PURPOSE

Postoperative soft tissue swelling is a significant factor influencing outcomes after elbow surgery. It can crucially affect important parameters such as postoperative mobilization, pain, and subsequently the range of motion (ROM) of the affected limb. Furthermore, lymphedema is considered a significant risk factor for numerous postoperative complications. Manual lymphatic drainage is nowadays part of the standardized post-treatment concept, basing on the concept of activating the lymphatic tissue to absorb stagnated fluid from the tissue into the lymphatic system. This prospective study aims to investigate the influence of technical device-assisted negative pressure therapy (NP) on early functional outcomes after elbow surgery. NP was therefore compared to manual lymphatic drainage (MLD). Is a technical device-based NP suitable for treatment of lymphedema after elbow surgery?

METHODS

A total of 50 consecutive patients undergoing elbow surgery were enrolled. The patients were randomized into 2 groups. 25 participants per group were either treated by conventional MLD or NP. The primary outcome parameter was defined as the circumference of the affected limb in cm postoperative up to seven days postoperatively. The secondary outcome parameter was a subjective perception of pain (measured via visual analogue scale, VAS). All parameters were measured on each day of postoperative inpatient care.

RESULTS AND CONCLUSION

NP showed an overall equivalent influence compared to MLD in reducing upper limb swelling after surgery. Moreover, the application of NP showed a significant decrease in overall pain perception compared to manual lymphatic drainage on days 2, 4 and 5 after surgery (p <  0.05).

CONCLUSION

Our findings show that NP could be a useful supplementary device in clinical routine treating postoperative swelling after elbow surgery. Its application is easy, effective and comfortable for the patient. Especially due to the shortage of healthcare workers and physical therapists, there is a need for supportive measures which NP could be.

Evaluating the accuracy of three-dimensional surface-imaging for circumference analysis of the thigh

BACKGROUND

Three-dimensional (3D) surface-imaging is an increasingly popular and useful tool in surgical planning and evaluation. These systems are used for anthropometric measurements of the face, breast and upper extremity. Its accuracy has, however, not yet been evaluated for the thigh. This could prove useful in the evaluation of autologous breast reconstructions using fasciocutaneous tissue of the thigh, such as the profunda artery perforator (PAP) flap.

METHODS

Thirty-five patients who underwent PAP flap surgery and 35 healthy controls were included. Thigh circumferences were measured using a flexible measuring tape at pre-defined levels. 3D images of the thigh were taken with the Canfield Vectra XT and fused to create 3D reconstructions. 3D circumferences were measured using the Vectra Analysis Module. Measuring tape and 3D circumferences were compared for mutual agreement.

RESULTS

Thigh circumference measurements by measuring tape correlated excellently with 3D measurements (r = 0.999). Bland-Altman plots demonstrated good agreement with a mean difference of -1.2 mm between the measuring tape and 3D measurements. The mean relative difference of both methods was -0.24%. Paired t-tests showed no significant statistical differences between the measuring tape and 3D circumference measurements in legs that underwent PAP flap surgery and without.

CONCLUSIONS

Flexible measuring tape and 3D circumference measurements of the thigh show excellent correlation. Three-dimensional surface imaging can thus be used to measure thigh circumferences in both patients with and without prior surgery of the thigh.

Circumferential Acquired Macropenis: Definition, Literature Review and Proposal of Geometrically-Based Reduction Corporoplasty

Introduction

Over the years, scattered cases of acquired penile girth increase have been published with different terms, the common clinical feature being a mechanically hampered penetration.

Aim

To search for all published cases of acquired penile girth increase, and to propose a geometrically-based reduction corporoplasty.

Methods

A case of acquired penile bilateral albuginea herniation prompted us to a PubMed, EMBASE and Google Scholar literature review from 1970 to 2021, in search for similar conditions.

Main Outcome Measure

We identified 7 cases of acquired penile girth increase; the geometric approach used to surgically correct bilateral corporal herniation proved successful in our case.

Results

In 5 of the 7 cases of acquired penile girth increase, priapistic episodes were deemed the causal factor; in the remaining 2 and in ours, a clear etiology could not be identified.

Conclusion

“Circumferential acquired macropenis” describes the unusual syndrome of acquired penile girth increase, that encompasses 2 distinct etiologies: post-priapistic cases, characterized by penile girth increase both in flaccidity and erection, and idiopathic cases, characterized by girth increase in erection only, and at surgery by a thinned albuginea in the affected area.

Pescatori ES, Drei B, Rabito S Circumferential Acquired Macropenis: Definition, Literature Review and Proposal of Geometrically-Based Reduction Corporoplasty. Sex Med 2022;10:100460.

Influence of thoracic endovascular aortic repair on true lumen helical morphology for Stanford type B dissections

OBJECTIVE

Thoracic endovascular aortic repair (TEVAR) can change the morphology of the flow lumen in aortic dissections, which may affect aortic hemodynamics and function. This study characterizes how the helical morphology of the true lumen in type B aortic dissections is altered by TEVAR.

METHODS

Patients with type B aortic dissection who underwent computed tomography angiography before and after TEVAR were retrospectively reviewed. Images were used to construct three-dimensional stereolithographic surface models of the true lumen and whole aorta using custom software. Stereolithographic models were segmented and co-registered to determine helical morphology of the true lumen with respect to the whole aorta. The true lumen region covered by the endograft was defined based on fiducial markers before and after TEVAR. The helical angle, average helical twist, peak helical twist, and cross-sectional eccentricity, area, and circumference were quantified in this region for pre- and post-TEVAR geometries.

RESULTS

Sixteen patients (61.3 ± 8.0 years; 12.5% female) were treated successfully for type B dissection (5 acute and 11 chronic) with TEVAR and scans before and after TEVAR were retrospectively obtained (follow-up interval 52 ± 91 days). From before to after TEVAR, the true lumen helical angle (-70.0 ± 71.1 to -64.9 ± 75.4°; P = .782), average helical twist (-4.1 ± 4.0 to -3.7 ± 3.8°/cm; P = .674), and peak helical twist (-13.2 ± 15.2 to -15.4 ± 14.2°/cm; P = .629) did not change. However, the true lumen helical radius (1.4 ± 0.5 to 1.0 ± 0.6 cm; P < .05) and eccentricity (0.9 ± 0.1 to 0.7 ± 0.1; P < .05) decreased, and the cross-sectional area (3.0 ± 1.1 to 5.0 ± 2.0 cm²; P < .05) and circumference (7.1 ± 1.0 to 8.0 ± 1.4 cm; P < .05) increased significantly from before to after TEVAR. The distinct bimodal distribution of chiral and achiral native dissections disappeared after TEVAR, and subgroup analyses showed that the true lumen circumference of acute dissections increased with TEVAR, although it did not for chronic dissections.

CONCLUSIONS

The unchanged helical angle and average and peak helical twists as a result of TEVAR suggest that the angular positions of the true lumen are constrained and that the endografts were helically conformable in the angular direction. The decrease of helical radius indicated a straightening of the corkscrew shape of the true lumen, and in combination with more circular and expanded lumen cross-sections, TEVAR produced luminal morphology that theoretically allows for lower flow resistance through the endografted portion. The impact of TEVAR on dissection flow lumen morphology and the interaction between endografts and aortic tissue can provide insight for improving device design, implantation technique, and long-term clinical outcomes.

Relationship between early-onset muscle soreness and indirect muscle damage markers and their dynamics after a full marathon

Background/Objective

Muscle soreness and damage occurs after completing a full marathon. Here we refer to muscle soreness induced by prolonged running as early-onset muscle soreness (EOMS) because muscle soreness and damage markers induced after prolonged running are different from delayed-onset muscle soreness (DOMS) and muscle damage markers induced after eccentric contraction, such as resistance exercise. The dynamics and relationship between muscle damage markers and EOMS are unclear; therefore, in this study, we aimed to elucidate the relationship between EOMS and indirect muscle damage markers, and their dynamics after a full marathon.

Methods

The following measurements were performed in 19 subjects who completed a full marathon: perceived muscle soreness (using a numeric rating scale), thigh circumference (CIR), hip joint range of motion (ROM), jump height (JH) and muscle damage marker activities in the blood (CK, AST, LDH, ALD) before (Pre), after (Post) and every day for 4 days after a full marathon (D1−4).

Results

EOMS was induced, as determined by the numeric rating scale score peaking immediately after a full marathon. ROM and JH significantly decreased and all muscle damage markers significantly increased after a full marathon. Serum CK and AST peaked at D1. Serum LDH and ALD peaked at Post and D3. Each marker showed different dynamics. CIR significantly decreased after a full marathon.

Conclusion

Muscle soreness peaked and muscle damage markers in the blood showed different dynamics after a full marathon. In other words, this is different from DOMS.

Effect of several try-in attempts of crimped preformed metal crowns on their circumference

AIM

To assess whether several try-in attempts change the circumference of preformed metal crowns (PMCs).

METHODS

This in vitro, experimental study was performed on 68 PMCs of maxillary and mandibular molars that required crimping. First, a photograph was obtained of the gingival margin of each crown using a digital camera (fixed at a specific distance). Crown margins were then crimped using 114 pliers. The second photograph was obtained under the same conditions as the first one. After crimping, the crowns were removed using an excavator to assess the amount of crimping. This was repeated for the second time and a photograph was obtained after each time of PMC removal. The crown was crimped again and tried on the tooth and a photograph was obtained after completion of each phase. Photographs were saved in a computer and the circumference of the crowns was calculated using AutoCAD software.

RESULTS

The reduction in circumference of the crowns following the first crimping was greater for the primary second molars than for the primary first molars and was on average 0.87%. After trying the crowns on teeth, the circumference of the crowns increased on average by 0.33%. This increase was 0.53% after trying the crowns for the second time. The reduction in circumference after the second crimping was 0.51%. There was an increase in circumference after re-trying of 0.35%. Changes in circumference of the crowns after the first (p = 0.037) and second (p = 0.00) try-in attempts were statistically significant.

CONCLUSIONS

Re-crimping is necessary after trying the crown on tooth and prior to cementation.

Neither slim nor fat: estimating the mass of the dodo (Raphus cucullatus, Aves, Columbiformes) based on the largest sample of dodo bones to date

The dodo (Raphus cucullatus) might be the most enigmatic bird of all times. It is, therefore, highly remarkable that no consensus has yet been reached on its body mass; previous scientific estimates of its mass vary by more than 100%. Until now, the vast amount of bones stored at the Natural History Museum in Mauritius has not yet been studied morphometrically nor in relation to body mass. Here, a new estimate of the dodo’s mass is presented based on the largest sample of dodo femora ever measured (n = 174). In order to do this, we have used the regression method and chosen our variables based on biological, mathematical and physical arguments. The results indicate that the mean mass of the dodo was circa 12 kg, which is approximately five times as heavy as the largest living Columbidae (pigeons and doves), the clade to which the dodo belongs.

Influence of cigarette circumference on smoke chemistry, biological activity, and smoking behaviour

Cigarettes with reduced circumference are increasingly popular in some countries, hence it is important to understand the effects of circumference reduction on their burning behaviour, smoke chemistry and bioactivity. Reducing circumference reduces tobacco mass burn rate, puff count and static burn time, and increases draw resistance and rod length burned during puff and smoulder periods. Smoulder temperature increases with decreasing circumference, but with no discernible effect on cigarette ignition propensity during a standard test. At constant packing density, mainstream (MS) and sidestream (SS) tar and nicotine yields decrease approximately linearly with decreasing circumference, as do the majority of smoke toxicants. However, volatile aldehydes, particularly formaldehyde, show a distinctly non-linear relationship with circumference and increases in the ratios of aldehydes to tar and nicotine have been observed as the circumference decreases. Mutagenic, cytotoxic and tumorigenic specific activities of smoke condensates (i.e. per unit weight of condensate) decrease as circumference decreases. Recent studies suggest that there is no statistical difference in mouth-level exposure to tar and nicotine among smokers of cigarettes with different circumferences. Commercially available slim cigarettes usually have changes in other cigarette design features compared with cigarettes with standard circumference, so it is difficult to isolate the effect of circumference on the properties of commercial products. However, available data shows that changes in cigarette circumference offer no discernible change to the harm associated with smoking.

Anthropometric Profile and Special Judo Fitness levels of Indian Judo Players

PURPOSE

Judo is a complex sport where different anthropological parameters determine performance. Judo, as a sport is not well known in India. There is evident lack of data concerning the anthropological determinants of judo players. This study was conducted to determine the anthropometric profile and Special Judo Fitness levels of judokas.

METHODS

This cross sectional study was conducted on 31 judo players. Anthropometric profile was assessed by measuring height, weight, body mass index, body circumferences at seven sites, seven site skin fold thickness and body fat percentage as per standard accepted protocol. Special Judo Fitness Test - a specific test to evaluate the judo athlete's physical condition was applied. Statistical analysis done using Student's unpaired 't' test and correlation by Karl Pearson's correlation coefficient.

RESULTS

Out of 31 judo players 20 had ≤5 yrs of judo practice (A group) and 11 >5 yrs of judo (B group). Anthropometric findings of both the judo groups were the same. Body fat has negative correlation (r =-0.690, P<0.05) with performance in SJFT. Observations during and after special judo fitness test were also similar.

CONCLUSIONS

Long term training has a minimal effect on anthropometry. Judo athletes of similar age when submitted to the same training type tend to show equal performance in the game and fitness levels after certain years of training. We also confirm existence of negative correlation between body fat and performance.

The Correlations between Extremity Circumferences with Total and Regional Amounts of Skeletal Muscle and Muscle Strength in Obese Women with Type 2 Diabetes

BACKGROUND

Insulin resistance is related to central obesity and the amount of skeletal muscle. A simple and practical anthropometric marker for muscle mass is not known, although waist circumference (WC) is used as an indicator of abdominal obesity. The aims of this study were to investigate whether arm (AC) and thigh circumferences (TC) can be used as an indicator of muscle mass and if they are related to muscle strength.

METHODS

A total of 110 obese (body mass index [BMI]≥25 kg/m(2)) women with type 2 diabetes were enrolled, and WC, AC, and TC were measured. Abdominal visceral fat (AVF), subcutaneous fat (ASF), and total fat (ATF) were assessed by computed tomography, regional muscle (MM), and fat mass by dual-energy X-ray absorptiometry, muscle strength by one repetition maximum (1RM) of both extremities (chest and leg press) and insulin resistance by K(ITT).

RESULTS

The mean age was 56.2±7.3 years, duration of diabetes was 4.2±4.4 years, and BMI was 27.2±2.8 kg/m(2). WC was correlated with ATF, AVF, and ASF (r=0.728, P<0.001; r=0.515, P<0.001; r=0.608, P<0.001, respectively). Arm MM was correlated with AC (r=0.500, P<0.001), and leg MM with TC (r=0.291, P=0.002). Upper 1RM was related to AC/WC ratio (r=0.359, P<0.001), and lower 1RM was to TC/WC ratio (r=0.286, P=0.003). Insulin resistance had significant relations with AVF, WC, and total MM (r=-0.262, P=0.008; r=-0.217, P=0.029; r=0.160, P=0.031, respectively).

CONCLUSION

The muscle mass was related to extremity circumferences, and muscle strength was to extremity/waist circumference ratio in obese women with type 2 diabetes.

Magnetic resonance pelvimetry for trial of labour after a previous caesarean section

OBJECTIVES

To stratify the magnetic resonance (MR) pelvimetric diameters according to mode of delivery and establish possible reference values for pelvic diameters and outlet index for trial of labor after a previous caesarean section.

METHODS

This is a retrospective study of 125 patients at Sultan Qaboos University Hospital who underwent MR pelvimetry prior to a trial of vaginal delivery after a previous caesarean section between May 2001 and October 2003. Sagittal inlet, Transverse inlet, interspinous diameter, sagittal outlet and transverse outlet diameters were measured in all patients. The mean diameters were stratified according to delivery modality (vaginal delivery or caesarean section). The outlet index (sum of interspinous, sagittal outlet and intertuberous diameters), biparietal diameter of the foetus and head circumference were compared in women who delivered by caesarean section or vaginally.

RESULTS

All the diameters except sagittal inlet, were significantly larger (P < 0.05) in women who delivered normally as compared with those who had a caesarean section for any indication. The mean outlet index in the spontaneous delivery group with vertex presentation 31.89 ± 2.05, was significantly larger than that of the elective and emergency caesarean section, which were 29.69 ± 1.85 & 30.62 ± 1.80 respectively. The mean head circumference was also found to be significantly larger in the caesarean section deliveries.

CONCLUSION

An outlet index of 31.89 ± 2.05 and the pelvic diameters, transverse inlet 12.56 ± 0.80cm, sagittal outlet 10.54 ± 1.00 cm, interspinous diameter10.46 ± 0.89cm, and intertuberous diameter (transverse outlet) 10.89 ± 1.02cm are useful cut-off points for vaginal delivery in our population.