Clinical outcome of increased flexion gap after total knee arthroplasty. Can controlled gap imbalance improve knee flexion?

PURPOSE: Increased range of motion (ROM) while maintaining joint stability is the goal of modern total knee arthroplasty (TKA). A biomechanical study has shown that small increases in flexion gap result in decreased tibiofemoral force beyond 90° flexion. The purpose of this paper was to investigate clinical implications of controlled increased flexion gap. METHODS: Four hundred and four TKAs were allocated into one of two groups and analysed retrospectively. In the first group (n = 352), flexion gap exceeded extension gap by 2.5 mm, while in the second group (n = 52) flexion gap was equal to the extension gap. The procedures were performed from 2008 to 2012. The patients were reviewed 12 months postoperatively. Objective clinical results were assessed for ROM, mediolateral and sagittal stability. Patient-reported outcome measures were the WOMAC score and the Forgotten Joint Score (FJS-12). RESULTS: After categorizing postoperative flexion into three groups (poor < 90°, satisfactory 91°-119°, good ≥ 120°) significantly more patients in group 1 achieved satisfactory or good ROM (p = 0.006). Group 1 also showed a significantly higher mean FJS-12 (group 1: 73, group 2: 61, p = 0.02). The mean WOMAC score was 11 in the first and 14 in the second group (n.s.). Increase in flexion gap did not influence knee stability. CONCLUSIONS: The clinical relevance of this study is that a controlled flexion gap increase of 2.5 mm may have a positive effect on postoperative flexion and patient satisfaction after TKA. Neither knee stability in the coronal and sagittal planes nor complications were influenced by a controlled increase in flexion gap. LEVEL OF EVIDENCE: III.

A newly discovered muscle: The tensor of the vastus intermedius.

The quadriceps femoris is traditionally described as a muscle group composed of the rectus femoris and the three vasti. However, clinical experience and investigations of anatomical specimens are not consistent with the textbook description. We have found a second tensor-like muscle between the vastus lateralis (VL) and the vastus intermedius (VI), hereafter named the tensor VI (TVI). The aim of this study was to clarify whether this intervening muscle was a variation of the VL or the VI, or a separate head of the extensor apparatus. Twenty-six cadaveric lower limbs were investigated. The architecture of the quadriceps femoris was examined with special attention to innervation and vascularization patterns. All muscle components were traced from origin to insertion and their affiliations were determined. A TVI was found in all dissections. It was supplied by independent muscular and vascular branches of the femoral nerve and lateral circumflex femoral artery. Further distally, the TVI combined with an aponeurosis merging separately into the quadriceps tendon and inserting on the medial aspect of the patella. Four morphological types of TVI were distinguished: Independent-type (11/26), VI-type (6/26), VL-type (5/26), and Common-type (4/26). This study demonstrated that the quadriceps femoris is architecturally different from previous descriptions: there is an additional muscle belly between the VI and VL, which cannot be clearly assigned to the former or the latter. Distal exposure shows that this muscle belly becomes its own aponeurosis, which continues distally as part of the quadriceps tendon.

Search for solar axions by the CERN axion solar telescope with 3He buffer gas: closing the hot dark matter gap.

The CERN Axion Solar Telescope has finished its search for solar axions with (3)He buffer gas, covering the search range 0.64 eV ≲ ma ≲ 1.17 eV. This closes the gap to the cosmological hot dark matter limit and actually overlaps with it. From the absence of excess x rays when the magnet was pointing to the Sun we set a typical upper limit on the axion-photon coupling of gaγ ≲ 3.3 × 10(-10) GeV(-1) at 95% C.L., with the exact value depending on the pressure setting. Future direct solar axion searches will focus on increasing the sensitivity to smaller values of gaγ, for example by the currently discussed next generation helioscope International AXion Observatory.

Search for sub-eV mass solar axions by the CERN Axion Solar Telescope with 3He buffer gas.

The CERN Axion Solar Telescope (CAST) has extended its search for solar axions by using (3)He as a buffer gas. At T=1.8 K this allows for larger pressure settings and hence sensitivity to higher axion masses than our previous measurements with (4)He. With about 1 h of data taking at each of 252 different pressure settings we have scanned the axion mass range 0.39 eV≲m(a)≲0.64 eV. From the absence of excess x rays when the magnet was pointing to the Sun we set a typical upper limit on the axion-photon coupling of g(aγ)≲2.3×10(-10) GeV(-1) at 95% C.L., the exact value depending on the pressure setting. Kim-Shifman-Vainshtein-Zakharov axions are excluded at the upper end of our mass range, the first time ever for any solar axion search. In the future we will extend our search to m(a)≲1.15 eV, comfortably overlapping with cosmological hot dark matter bounds.

Clinical outcome using a ligament referencing technique in CAS versus conventional technique.

PURPOSE: Computer-assisted surgery (CAS) for total knee arthroplasty (TKA) has become increasingly common over the last decade. There are several reports including meta-analyses that show improved alignment, but the clinical results do not differ. Most of these studies have used a bone referencing technique to size and position the prosthesis. The question arises whether CAS has a more pronounced effect on strict ligamentous referencing TKAs. METHODS: We performed a prospective cohort study comparing clinical outcome of navigated TKA (43 patients) with that of conventional TKA (122 patients). Patients were assessed preoperatively, and 2 and 12 months postoperatively by an independent study nurse using validated patient-reported outcome tools as well as clinical examination. RESULTS: At 2 months, there was no difference between the two groups. However, after 12 months, CAS was associated with significantly less pain and stiffness, both at rest and during activities of daily living, as well as greater overall patient satisfaction. CONCLUSION: The present study demonstrated that computer-navigated TKA significantly improves patient outcome scores such as WOMAC score (P=0.002) and Knee Society score (P=0.040) 1 year after surgery in using a ligament referencing technique. Furthermore, 91% were extremely or very satisfied in the CAS TKA group versus 70% after conventional TKA (P=0.007).

[Periprosthetic fractures of the knee joint]. / Periprothetische Frakturen am Kniegelenk.

The demographic developments and an increasing number of total knee replacements will lead to more periprosthetic fractures in the future. These fractures can be classified into intraoperative and postoperative. Revisions in particular are associated with a higher incidence of intra-operative fractures, specifically for the tibia and patella. Most fractures occur in the postoperative period with an average of 2-4 years after the primary procedure. Most commonly the femur is involved. The history and clinical examination as well as imaging are crucial for the treatment as loose components would significantly alter the treatment strategy. In this case a revision has to be carefully planned. In the majority of the cases the prosthesis is well fixed especially at the femur. An open reduction internal fixation (ORIF) can then be carried out. A stable situation must be achieved to provide early post-operative mobilization. Also an anatomic reduction should be achieved with correct alignment especially with respect to varus/valgus and rotation. Modern locked implants can provide this with good success also with the possibility of minimally invasive techniques and polyaxial screw positioning. Retrograde intramedullary devices can be a feasible alternative. Similar principles can be used for the tibia whereas the patella can be stabilized with tension band wiring in the case of good bone stock but still remains a problem in case of bad bone stock.

Early results in the treatment of proximal humeral fractures with a polyaxial locking plate.

OBJECTIVES: We report early results using a second generation locking plate, non-contact bridging plate (NCB PH((R)), Zimmer Inc. Warsaw, IN, USA), for the treatment of proximal humeral fractures. The NCB PH combines conventional plating technique with polyaxial screw placement and angular stability. DESIGN: Prospective case series. SETTING: A single level-1 trauma center. PATIENTS: A total of 50 patients with proximal humeral fractures were treated from May 2004 to December 2005. INTERVENTION: Surgery was performed in open technique in all cases. MAIN OUTCOME MEASURES: Implant-related complications, clinical parameters (duration of surgery, range of motion, Constant-Murley Score, subjective patient satisfaction, complications) and radiographic evaluation [union, implant loosening, implant-related complications and avascular necrosis (AVN) of the humeral head] at 6, 12 and 24 weeks. RESULTS: All fractures available to follow-up (48 of 50) went to union within the follow-up period of 6 months. One patient was lost to follow-up, one patient died of a cause unrelated to the trauma, four patients developed AVN with cutout, one patient had implant loosening, three patients experienced cutout and one patient had an axillary nerve lesion (onset unknown). The average age- and gender-related Constant Score (n = 35) was 76. CONCLUSIONS: The NCB PH combines conventional plating technique with polyaxial screw placement and angular stability. Although the complication rate was 19%, with a reoperation rate of 12%, the early results show that the NCB PH is a safe implant for the treatment of proximal humeral fractures.

The variation in medial and lateral collateral ligament strain and tibiofemoral forces following changes in the flexion and extension gaps in total knee replacement. A laboratory experiment using cadaver knees.

Achieving deep flexion after total knee replacement remains a challenge. In this study we compared the soft-tissue tension and tibiofemoral force in a mobile-bearing posterior cruciate ligament-sacrificing total knee replacement, using equal flexion and extension gaps, and with the gaps increased by 2 mm each. The tests were conducted during passive movement in five cadaver knees, and measurements of strain were made simultaneously in the collateral ligaments. The tibiofemoral force was measured using a customised mini-force plate in the tibial tray. Measurements of collateral ligament strain were not very sensitive to changes in the gap ratio, but tibiofemoral force measurements were. Tibiofemoral force was decreased by a mean of 40% (SD 10.7) after 90 degrees of knee flexion when the flexion gap was increased by 2 mm. Increasing the extension gap by 2 mm affected the force only in full extension. Because increasing the range of flexion after total knee replacement beyond 110 degrees is a widely-held goal, small increases in the flexion gap warrant further investigation.

Effects of ligation of lateral intermuscular septum perforating vessels on blood supply to the femur.

INTRODUCTION: With a subvastus approach to the femur, the vessels that perforate the lateral intermuscular septum (LISP-vessels) must be ligated. The effect on the blood supply to the femur remains unclear. The purpose of the current study was to investigate the effect of ligation of the LISP-Vessels on the blood supply and to examine the anatomy of the LISP-vessels and the anastomoses around the femur. MATERIALS: In six human cadavers the LISP vessels were ligated by a lateral subvastus approach on one side. The contralateral side served as control group. After bilateral injection of different coloured silicon dyes into the lateral and medial circumflex femoral artery (green), deep femoral artery (red) and the superficial femoral artery (blue) dissection was performed bilaterally. The arterial perfusion on both sides was compared and the anatomy of the LISP vessels studied. RESULTS: The medullary perfusion of the femur was not altered by the ligation of the LISP vessels. It did also not lead to a decrease in periosteal vessel filling. The LISP vessels were shown to be a part of a complex and rich anastomotic network and play an important role in the perfusion of the femur and quadriceps muscle group. The ligature could be compensated for by this anastomotic network. Branches to the periosteum separate from the LISP vessels immediately after perforating the lateral intermuscular septum. The linea aspera turned out to be an important area for the femoral blood supply. DISCUSSION AND CONCLUSIONS: Exposure of the femur through a lateral subvastus approach with ligation of LISP vessels causes a certain degree of soft tissue trauma. However, by using a gentle surgical technique the periostal perfusion of the femur can be preserved by a potent anastomotic network after ligation of the LISP vessels if they are not ligated to close to the lateral intermuscular septum and the linea aspera is not unnecessarily exposed.

Influence of dentinal fluid and stress on marginal adaptation of resin composites.

The influence of dentinal fluid and of a number of stress procedures on the quality of the margins of class V restorations located in both enamel and dentin was quantitatively assessed in vitro with the aid of a scanning electron microscope. The materials tested were GLUMA 2000 experimental, Prisma Universal Bond 3, and Syntac, together with the fine hybrid composites supplied by the respective manufacturers (Pekafill, AP.H, and Tetric). All materials achieved over 95% of "continuous margin" in enamel before and after stressing. In dentin, the initial values, with as well as without dentinal fluid simulation, were situated between 93.2 and 98.2%. With GLUMA 2000 experimental after stressing, a "continuous margin" occurred in only 50.2%, but with Prisma Universal Bond 3 and Syntac, the value was 79.0%. The influence of dentinal fluid simulation was dependent on the dentinal adhesive used. The effects of the various stress procedures were not significantly different.

The benefits of wearing a compression sleeve after ACL reconstruction.

PURPOSE: It was the purpose of the present study to examine the possibility of increased muscle coordination after anterior cruciate ligament (ACL) reconstruction through the wearing of a compression sleeve. METHODS: Thirty-six patients were studied who had undergone unilateral ACL reconstruction at least 12 months previously. All subjects were required to perform a 10-cm standing drop jump from an elevated platform onto a force plate, to land on one leg, and thereafter maintain a one-legged balance for 25 s. This task was repeated three times without and three times with an elastic compression sleeve worn on the reconstructed limb. For analysis, the task was partitioned into a landing phase (150 ms), an adjusting phase (10s), and a balancing phase (10s). The peak impact loadings were measured in each direction (Fx, Fy, and Fz) during landing, while force-time integrals (intFz, intFy, and intFz) and root mean square (RMS) error of these forces were calculated for the adjusting and balancing phases. The path length and RMS of the center of pressure coordinates (Ax and Ay) were obtained for the adjusting and balancing phases combined. RESULTS: Drop landings with the bandage produced significantly larger (P < 0.001) peak ground reaction forces in the vertical and anteroposterior direction, suggesting increased subject confidence in their knee. Wearing the knee bandage also enabled the patients to reduce all measured parameters in the anteroposterior direction (rmsFx, intFx, rmsAx) during both the adjusting and balancing phases (P < 0.001 ). A significant reduction in the center of pressure path length further indicated an enhanced steadiness during the one-legged stance. CONCLUSIONS: It was concluded that a compression sleeve improved the total integration of the balance control system and muscle coordination.

Endurance sports after total knee replacement: a biomechanical investigation.

PURPOSE: No biomechanical evaluation of total knee designs exists for loads occurring during sports activities. It was the purpose of the present study to evaluate the contact stress distribution and contact area of different knee joint designs for loads that occur during four common recreational endurance activities. METHODS: Three different total knee designs were evaluated for loads occurring during cycling (1.2 body weight (BW) at 80 degrees of knee flexion), power walking (4 BW at 20 degrees), hiking (8 BW at 40 degrees), and jogging (9 BW at 50 degrees) using Fuji pressure-sensitive film. The designs consisted of a flat tibial inlay, a curved inlay, and an inlay with mobile bearings. Five measurements were conducted for each load. The pressure sensitive films were scanned and analyzed using an image analysis program. RESULTS: During cycling, the area with stress levels above the yield point of polyethylene (overloaded area) was below 15 mm2 for each design. During power walking, the mobile bearing design showed no overloaded area, whereas it was below 50 mm2 for the flat and curved design. During downhill walking and jogging, more than 140 mm2 were overloaded for each design. CONCLUSIONS: It was concluded that patients after total knee replacement should alternate activities such as power walking and cycling. For mountain hiking, patients are advised to avoid descents or at least use ski poles. Jogging or sports involving running should be discouraged after total knee replacement.

Osteonecrosis of the humeral head after extracorporeal shock-wave lithotripsy.

A 59-year-old woman with calcific tendinitis in her right shoulder underwent extracorporeal shock-wave lithotripsy. Three years and four months later she presented with osteonecrosis of the head of the right humerus. It is known that shock waves in patients with urological disorders can damage blood vessels. A possible reason for the development of osteonecrosis in this patient may have been damage to the blood supply of the head of the humerus.

Joint load considerations in total knee replacement.

Estimates of knee joint loadings were calculated for 12 normal subjects from kinematic and kinetic measures obtained during both level and downhill walking. The maximum tibiofemoral compressive force reached an average load of 3.9 times body-weight (BW) for level walking and 8 times BW for downhill walking, in each instance during the early stance phase. Muscle forces contributed 80% of the maximum bone-on-bone force during downhill walking and 70% during level walking whereas the ground reaction forces contributed only 20% and 30% respectively. Most total knee designs provide a tibiofemoral contact area of 100 to 300 mm2. The yield point of these polyethylene inlays will therefore be exceeded with each step during downhill walking. Future evaluation of total knee designs should be based on a tibiofemoral joint load of 3.5 times BW at 20 degrees knee flexion, 8 times BW at 40 degrees and 6 times BW at 60 degrees.

Lack of correlation between different measurements of proprioception in the knee.

Current methods of measurement of proprioceptive function depend on the ability to detect passive movement (kinaesthesia) or the awareness of joint position (joint position sense, JPS). However, reports of proprioceptive function in healthy and pathological joints are quite variable, which may be due to the different methods used. We have compared the validity of several frequently used methods to quantify proprioception. Thirty healthy subjects aged between 24 and 72 years underwent five established tests of proprioception. Two tests were used for the measurement of kinaesthesia (KT1 and KT2). Three tests were used for the measurement of JPS, a passive reproduction test (JPS1), a relative reproduction test (JPS2) and a visual estimation test (JPS3). There was no correlation between the tests for kinaesthesia and JPS or between the different JPS tests. There was, however, a significant correlation between the tests for kinaesthesia (r = 0.86). We conclude therefore that a subject with a given result in one test will not automatically obtain a similar result in another test for proprioception. Since they describe different functional proprioceptive attributes, proprioceptive ability cannot be inferred from independent tests of either kinaesthesia or JPS.

[Sex- or symptom-specific behavior of male residents? An analysis of diagnosis and therapy of ambulatory female and male patients with abdominal pain]. / Geschlechts- oder symptomspezifisches Verhalten männlicher Assistenzärzte? Eine Analyse von Diagnostik und Therapie bei ambulanten Patientinnen und Patienten mit Bauchschmerzen.

We investigated the influence of the patient's gender for diagnostic and therapeutic approach of physicians at the outpatient clinic of the university hospital of Basle. In a prospective study 13 male residents in their second and third year of medical training were observed in their management of 25 female and 25 male patients presenting with the leading complaint of abdominal pain with regard to taking of the medical history, the physical examination and the performed diagnostic and therapeutic procedures, without informing the participating physicians. The time spent for the first consultation and the number of follow ups performed were registered. Following differences in the management of female and male patients were observed: The time spent at the first consultation was 59 +/- 5 minutes in female and 45 +/- 3.5 in male patients (p less than 0.03). Fundoscopic examination was three times more often performed in female patients. Endoscopic examinations were more often observed in male patients (p less than 0.01). Antacids and H2-antagonists were more frequently prescribed in male (p less than 0.01). Spasmolytics and laxatives more frequently in female (p less than 0.01). In summary in male patients the diagnosis of functional disease was predominantly made after exclusion of an organic disease what does explain the use of more diagnostic procedures and the induction of a more specific therapy.

[Effects of sports and media consumption on the trunk muscle strength, posture and flexibility of the spine in 12- to 14- year-old adolescents]. / Effekte von Sport und Medienkonsum auf Rumpfkraft, Haltung und Beweglichkeit der Wirbelsäule bei 12- bis 14-jährigen Jugendlichen.

INTRODUCTION: Back pain and posture deficits get more common in childhood and adolescents. Lack of movement, insufficient physical education and high amounts of TV and PC are known as risk factors for chronic low back pain in later life. METHODS: In a cross-sectional study, trunk muscle strength, posture and spinal flexibility were assessed in 200 untrained schoolchildren (117 girls, 83 boys). Independent variables, collected by a standardized questionnaire: age, height, weight, gender, weekly scope of TV, PC and sports (conditional, conditional-coordinative, coordinative). DEPENDENT VARIABLES: spinal parameter, tested by the Zebris CMS-System and IPN Back Check. OUTCOMES: PC and TV-consumption had negative effects on the spinal parameter, whereas esp. conditional-coordinative sports correlated positively. DISCUSSION: For general health and preventive reasons, children need a daily minimum of 30 minutes of movement. Conditional-coordinative sports are suited best because of their multifactorial load.

Echocardiographic parameters in dogs treated with acepromazine and fentanyl / Parâmetros ecocardiográficos em cães tratados com acepromazina e fentanil

Considering that the use of tranquillizers could optimize the performance of the echocardiogram, this study aimed to evaluate the effect of protocols with acepromazine and fentanyl on the echocardiographic parameters of healthy dogs, besides their effect in systolic blood pressure (SBP), respiratory rate (RR), heart rate (HR), time spent for examination and sedation scale. Ten adult dogs were submitted to different tranquilizing protocols 20 minutes before the echocardiographic examination, totalling five treatments for each pair, performed at seven-day intervals between evaluations. The treatments were CT (control treatment), IAT (intramuscular acepromazine), OAT (oral acepromazine), FT (fentanyl) and AFT (acepromazine associated with fentanyl). In addition to the echocardiographic evaluation, SBP, degree of reassurance, duration of the exam, HR and RR in the different protocols were evaluated. There was a significant decrease of SBP in OAT. There was a significant reduction in left ventricular diameter during systole and diastole and mitral annular movement in IAT, OAT and AFT, compared with CT. There was a decrease in tricuspid annular plane systolic excursion and increase in mitral E/mitral A ratio in IAT and OAT when compared with CT. All the tranquillizer protocols studied were found to significantly reduce HR, that facilitated the echocardiographic examination.(AU)

Considerando que o uso de tranquilizantes poderia otimizar a realização do ecocardiograma, objetivou-se com este estudo avaliar o efeito da tranquilização com acepromazina e fentanil sobre os parâmetros ecocardiográficos em cães saudáveis, bem como o efeito na pressão arterial sistólica (PAS), na frequência respiratória (FR), na frequência cardíaca (FC), no tempo gasto para a realização do exame e na escala de sedação. Dez cães adultos foram submetidos a diferentes protocolos tranquilizantes, 20 minutos antes da avaliação ecocardiográfica, totalizando cinco tratamentos para cada dupla, realizados com intervalos de sete dias entre as avaliações. Os tratamentos foram: TC (tratamento controle), TAI (acepromazina intramuscular), TAO (acepromazina oral), TF (fentanil) e TAF (acepromazina associada ao fentanil). Além dos parâmetros ecocardiográficos, foram avaliados a PAS, o grau de tranquilização, o tempo de duração do exame e a FC e a FR nos diferentes protocolos. Houve diminuição significativa da PAS no TAO. Observou-se redução significativa do diâmetro do ventrículo esquerdo em sístole e diástole e do movimento anular de mitral nos protocolos TAI, TAO e TAF, comparados com o TC. Observou-se também uma redução da excursão sistólica do plano anular tricúspide e aumento da relação mitral E/mitral A nos protocolos TAI e TAO quando comparados ao TC. Todos os protocolos de tranquilização reduziram significativamente a FC, o que facilitou a realização do exame.(AU)

Effect of exercise on cardiovascular parameters in search and rescue-trained dogs / Efeito do exercício sobre parâmetros cardiovasculares em cães em treinamento de busca, resgate e salvamento

Physical activity alters the cardiovascular system of dogs, depending on the exercise characteristics and the animal's physical conditioning. Little is known about the cardiovascular changes in rescue-trained dogs. This study evaluated the cardiovascular responses to a search and rescue exercise session to differentiate these alterations from cases of exhaustion or some possible pathology. Nine healthy rescue-trained dogs that trained for at least one year were used. Seven German Shepherds and two Belgian Shepherd Malinois were evaluated twice, immediately before exercise (M0) and immediately after a 20-minute training (M1). Electrocardiographic, echocardiographic, and systemic blood pressure (SBP) measurements were performed at each evaluation. Heart rate was evaluated in three moments, M0, M1 and five minutes after the end of the physical activity (M2). The results indicated that training increased oxygen demand and significantly increased cardiac output, left ventricular volume in diastole and aortic artery diameter, and the contraction force with the increased mitral annular motion without impairing systolic and diastolic cardiac functions. Heart rate values immediately and five minutes after exercise were similar to baseline values. Training did not alter SBP and the electrocardiographic parameters. The present study indicated good cardiac performance to the physical effort of rescue-trained dogs and reduced the chances of poor performance and the occurrence of sudden death caused by exercise in response to the pattern of activity performed.(AU)

A atividade física acarreta diversas mudanças no sistema cardiovascular dos cães, dependendo das características do exercício realizado e do condicionamento físico do animal. Pouco se sabe sobre as alterações cardiovasculares causadas pelo treinamento de busca, resgate e salvamento. Objetivou-se, com este estudo, avaliar as respostas cardiovasculares após uma sessão desse tipo de treino, a fim de diferenciar essas alterações de casos de exaustão ou de alguma possível patologia. Foram utilizados nove cães saudáveis em treinamento de busca, resgate e salvamento há pelo menos um ano, sendo sete da raça Pastor Alemão e dois da raça Pastor Belga Malinois. Os cães foram submetidos a dois momentos de avaliação: M0 imediatamente antes do exercício e M1 imediatamente após um treinamento de 20 minutos. Em cada avaliação, foram realizados os exames eletrocardiográfico e ecocardiográfico e a aferição da pressão arterial sistólica sistêmica. Apenas a frequência cardíaca foi avaliada em três momentos, em M0, M1 e após cinco minutos do término da atividade física (M2). Os resultados obtidos indicam que o treinamento causa um aumento na demanda de oxigênio, provocando um aumento significativo no débito cardíaco, no volume ventricular esquerdo em diástole e no diâmetro da artéria aorta, assim como um aumento em um dos parâmetros de contratilidade cardíaca (movimento anular de mitral), sem causar prejuízo às funções cardíacas sistólicas e diastólicas. Os valores da FC imediatamente após e cinco minutos após o exercício foram similares aos valores basais. A PASS e os parâmetros eletrocardiográficos não se alteraram após o treinamento. Os achados encontrados indicam um bom desempenho cardíaco ao esforço físico dos cães de busca, resgate e salvamento, reduzindo-se as chances de má performance e de ocorrência de morte súbita causada pelo exercício, em resposta ao padrão da atividade realizada.(AU)

Distal tibiofibular radiological overlap: Does it always exist?

OBJECTIVES: Overlap between the distal tibia and fibula has always been quoted to be positive. If the value is not positive then an injury to the syndesmosis is thought to exist. Our null hypothesis is that it is a normal variant in the adult population. METHODS: We looked at axial CT scans of the ankle in 325 patients for the presence of overlap between the distal tibia and fibula. Where we thought this was possible we reconstructed the images to represent a plain film radiograph which we were able to rotate and view in multiple planes to confirm the assessment. RESULTS: The scans were taken for reasons other than pathology of the ankle. We found there was no overlap in four patients. These patients were then questioned about previous injury, trauma, surgery or pain, in order to exclude underlying pathology. CONCLUSION: We concluded that no overlap between the tibia and fibula may exist in the population, albeit in a very small proportion.