Rupture of Subcutaneous Peritoneal Dialysis Catheter by Stretching Exercise: A Case Report.

Rupture of the peritoneal dialysis (PD) catheter is rare complication. Here, we report a case of catheter rupture that occurred because of exercise after partial catheter reimplantation.A 66-year-old man with a history of end-stage kidney disease secondary to diabetic nephropathy experienced refractory exit-site and tunnel infection. After the infected parts of the catheter were excised, a partial catheter reimplantation was performed. At the time of that surgery, a presternal location was selected for the new exit site, and a titanium extender was used to connect the two catheters. The patient was discharged on postoperative day 3, but was readmitted for a pericatheter leak 5 days later. Fluoroscopy performed to investigate the cause demonstrated a pericatheter leak from the connecting portion between the titanium extender and the catheter.Surgery performed to repair the leak revealed that the catheter had ruptured. We believe that the cause of the rupture was mechanical stress induced by the patient's stretching exercise program. The PD catheter was made of silicone rubber with high elasticity. Even when such resilient materials are used, we recommend that, to avoid PD catheter rupture after partial reimplantation, clinicians should discourage the patient from stretching excessively.

Flexibilidade, imagem corporal e índice de massa corporal de idosas praticantes de alongamento no Centro Desportivo Municipal (CDM) Santa Maria/2015 / Flexibility, body image and body mass index in elderly practitioners de stretching at Municipal Sports Centre (CDM) - Santa Maria/2015

Introdução: a terceira idade é um período que merece atenção, pois é neste período que gera alguma debilidade e fraquezas corporais nestas pessoas, e também a imagem corporal pode ser afetada, com isso a atividade física é de grande valor para estes indivíduos para melhorar sua autoestima e o seu convívio social, além da sua saúde corporal. Sabe-se que a atividade física é muito importante no processo de envelhecimento, para auxiliar na qualidade de vida e minimizar problemas futuros com idosos. Objetivo: avaliar o nível de flexibilidade, o índice de massa corporal (IMC) e a imagem corporal de um grupo de idosas praticantes de alongamento no Centro Desportivo Municipal (CDM). Materiais e métodos: realizou-se uma pesquisa diagnóstica, descritiva, exploratória com 22 alunas das aulas de alongamentos. Utilizou-se como instrumento de coleta de dados, avaliação da percepção da imagem corporal, massa corporal, estatura e o teste de flexibilidade. Resultados: notou-se que a maioria rejeita sua imagem corporal atual, querendo padrões melhores, referente ao índice de massa corporal (IMC) e na flexibilidade percebe-se uma boa qualidade desses valores em relação à idade dessas idosas, até mesmo pela prática do exercício físico que mostra o quão importante é para a saúde corporal de tal população. Conclusão: a atividade física é de suma importância para este grupo de idosas, pois ajuda a melhorar a flexibilidade para realizarem suas atividades diárias com melhor preparo e a imagem corporal de tais mulheres é relativamente um dos motivos que estão no alongamento, para melhorar esta percepção.

Introdução: a terceira idade é um período que merece atenção, pois é neste período que gera alguma debilidade e fraquezas corporais nestas pessoas, e também a imagem corporal pode ser afetada, com isso a atividade física é de grande valor para estes indivíduos para melhorar sua autoestima e o seu convívio social, além da sua saúde corporal. Sabe-se que a atividade física é muito importante no processo de envelhecimento, para auxiliar na qualidade de vida e minimizar problemas futuros com idosos. Objetivo: avaliar o nível de flexibilidade, o índice de massa corporal (IMC) e a imagem corporal de um grupo de idosas praticantes de alongamento no Centro Desportivo Municipal (CDM). Materiais e métodos: realizou-se uma pesquisa diagnóstica, descritiva, exploratória com 22 alunas das aulas de alongamentos. Utilizou-se como instrumento de coleta de dados, avaliação da percepção da imagem corporal, massa corporal, estatura e o teste de flexibilidade. Resultados: notou-se que a maioria rejeita sua imagem corporal atual, querendo padrões melhores, referente ao índice de massa corporal (IMC) e na flexibilidade percebe-se uma boa qualidade desses valores em relação à idade dessas idosas, até mesmo pela prática do exercício físico que mostra o quão importante é para a saúde corporal de tal população. Conclusão: a atividade física é de suma importância para este grupo de idosas, pois ajuda a melhorar a flexibilidade para realizarem suas atividades diárias com melhor preparo e a imagem corporal de tais mulheres é relativamente um dos motivos que estão no alongamento, para melhorar esta percepção.

Adverse events after manual therapy among patients seeking care for neck and/or back pain: a randomized controlled trial.

BACKGROUND: The safety of the manual treatment techniques such as spinal manipulation has been discussed and there is a need for more information about potential adverse events after manual therapy. The aim of this randomized controlled trial was to investigate differences in occurrence of adverse events between three different combinations of manual treatment techniques used by manual therapists (i.e. chiropractors, naprapaths, osteopaths, physicians and physiotherapists) for patients seeking care for back and/or neck pain. In addition women and men were compared regarding the occurrence of adverse events. METHODS: Participants were recruited among patients, ages 18-65, seeking care at the educational clinic of the Scandinavian College of Naprapathic Manual Medicine in Stockholm. The patients (n = 767) were randomized to one of three treatment arms 1) manual therapy (i.e. spinal manipulation, spinal mobilization, stretching and massage) (n = 249), 2) manual therapy excluding spinal manipulation (n = 258) and 3) manual therapy excluding stretching (n = 260). Treatments were provided by students in the seventh semester of total eight. Adverse events were measured with a questionnaire after each return visit and categorized in to five levels; 1) short minor, 2) long minor, 3) short moderate, 4) long moderate and 5) serious adverse events, based on the duration and/or severity of the event. Generalized estimating equations were used to examine the association between adverse event and treatments arms. RESULTS: The most common adverse events were soreness in muscles, increased pain and stiffness. No differences were found between the treatment arms concerning the occurrence of adverse event. Fifty-one percent of patients, who received at least three treatments, experienced at least one adverse event after one or more visits. Women more often had short moderate adverse events (OR = 2.19 (95% CI: 1.52-3.15)), and long moderate adverse events (OR = 2.49 (95% CI: 1.77-3.52)) compared to men. CONCLUSION: Adverse events after manual therapy are common and transient. Excluding spinal manipulation or stretching do not affect the occurrence of adverse events. The most common adverse event is soreness in the muscles. Women reports more adverse events than men. TRIAL REGISTRATION: This trial was registered in a public registry (Current Controlled Trials) (ISRCTN92249294).

Urinary incontinence triggered by stretching exercises.

A 47-year-old female patient who experienced urinary urgency after having stretching exercises of her legs is presented. Stretching of the legs are thought to be responsible for conus medullaris tethering which in turn causes urinary complaints. What is interesting in this case is that her complaints about urinary urgency stopped as she quit stretching exercise movements of her legs. There are some examples of such cases in the literature. The urinary urgency after stretching exercises warned us to investigate this patient in regard to tethered conus medullaris. Tethering of the conus medullaris can be temporary and can cause reversible functional disorders of the bladder. Incontinence at any age should be evaluated cautiously as it could be a sign of an underlying important developmental failure.

Dynamic displacement of the femoral head by hamstring stretching in children with cerebral palsy.

BACKGROUND: Hamstring stretching is an integral component in the treatment for knee flexion contracture in cerebral palsy (CP). As hamstrings span across hip and knee joints, passive stretching of hamstrings applies force to the hip that is often dysplasia in CP. The purpose of this study is to measure the dynamic displacement of femoral head produced by passive stretching of hamstrings and to determine the factors associated with the phenomenon. METHODS: Children with spastic CP were studied using computerized tomography (CT) of the pelvis. Two sets of CT studies were carried out, one with the knee flexed and the hip flexed (resting) and the other with the knee extended and the hip flexed to simulate manual hamstrings stretching. The distance from pelvic baseline to the posterior margin of femoral epiphysis was measured on the CT images and compared between resting and stretching for dynamic displacement. The dynamic displacement of the femoral head was expressed by a ratio to femoral epiphysis diameter. RESULTS: Twenty-seven CP children had CT studies at a mean age of 6.8 years (range: 4.5 to 9.6 y). Ten children were ambulators with or without devices and the other 17 children were nonambulators. On plain radiographs of the pelvis, the mean Reimer's migration percentage was 39% (range: 13% to 92%). On CT scan, dynamic displacement by stretching was 4.7% (range: -3.8% to 16.1%) of femoral epiphysis diameter (P<0.001 by paired t test). The displacement in the 33 hips with migration percentage of greater than 30% was significantly greater than the displacement in the other 21 hips with migration percentage of less than 30% (7.4% vs. 0.5%, P=0.001). CONCLUSIONS: Passive stretching of spastic hamstrings in the hip flexion position resulted in dynamic posterior displacement of the femoral head. Medical professionals should be aware of this fact, especially in spastic CP children with a higher migration percentage on radiograph. LEVEL OF EVIDENCE: Diagnostic II.

Treatment with inhibitors of the NF-kappaB pathway improves whole body tension development in the mdx mouse.

The whole body tension (WBT) method was used to evaluate the hypothesis that long term treatment with NF-kappaB inhibitors improves the total forward pulling tension exerted by the limb musculature of the mdx mouse. Mdx mice exhibited significantly reduced WBT values and more profound weakening during the course of generating multiple forward pulling movements than age-matched nondystrophic mice. Long term treatment with the NF-kappaB inhibitor pyrrolidine dithiocarbamate (PDTC) did not significantly reduce nuclear p65 activation in the costal diaphragm, but increased WBT by 12% in mature (12 month) mice. Daily treatment (30 days) of 1 month old mdx mice with the inhibitor ursodeoxycholic acid (UDCA) reduced costal diaphragm nuclear p65 activation by 40% and increased WBT by 21%. These results indicate that treatment with NF-kappaB inhibitors improves WBT in the mdx mouse and further establishes the utility of the WBT procedure in assessing therapeutic efficacy.

Efeitos de diferentes sessões de aquecimento no torque e amplitude articular de homens jovens / Effect of distinct warm up routines on torque production and range of motion in young males

Exercícios de flexibilidade são freqüentemente incluídos em sessões de aquecimento antes de exercíciosresistidos. No entanto, alguns autores sugerem que a prática de exercícios de alongamento podem afetarnegativamente performance de atividades que exijam força máxima. Sendo assim, o objetivo geral desseestudo foi verificar o impacto de três diferentes sessões de aquecimento na amplitude de movimento doquadril, pico de torque e trabalho total dos flexores do joelho direito. Dez homens treinados, sem histórico delesão neuromuscular, foram testados isocineticamente em três velocidades (60°/s, 90°/s e 120°/s) após trêsdiferentes sessões de aquecimento: 1) aquecimento geral (AG) no cicloergômetro; 2) aquecimento geral nocicloergômetro e alongamento estático (AE); 3) aquecimento geral no cicloergômetro e a técnica de facilitaçãoneuromuscular proprioceptiva hold-relax (FNP). A amplitude articular do quadril direito foi medido atravésde um goniômetro. As comparações foram feitas através de análise de variância com medidas repetidas eteste Post-Hoc de Bonferroni. (p < 0,05). Os resultados mostraram uma redução no pico de torque na sessãoFNP comparados aos da sessão AE na velocidade de 60°/s na fase concêntrica (AE: 150,8 + 21 Nm vs. FNP:140 + 22 Nm) e excêntrica (AE: 182,4 + 24,5 Nm vs. FNP: 168,5 + 27,8 Nm) e também menores quandocomparados ao dia de AG na velocidade de 120°/s (AG: 141,4 + 15,9 Nm vs. FNP: 129,2 + 18,4 Nm). Avariação do arco articular do quadril foi maior com o FNP (AE: 18,3 + 10,9 graus vs. FNP: 27,9 + 6,8 grauscomparado ao AE. Nós concluímos que a técnica FNP “hold-relax” pode influenciar de forma negativa osvalores de força voluntária máxima dos flexores de joelho, enquanto exercícios estáticos parecem não promoverefeito negativo. No entanto, para o aumento dos níveis de amplitude da articulação do quadril, a técnica FNP“hold-relax” parece ser a melhor opção.

Stretching exercises are commonly included in warm-up routines before resistance exercises. However, some authors suggest that stretching exercises may affect negatively activities that require maximalstrength. The purpose of this study was to verify the impact of three different warm-up sessions on hiprange of motion (ROM), peak torque and total work of right knee flexors of young adults. Ten trainedmen without neuromuscular injury were tested isocinetically at three velocities (60º/s, 90º/s and 120º/s) afterdifferent warm-up sessions: stationary bike (B), stationary bike and static stretch (S), stationary bike and hold-relax technique (FNP). The right hip ROM variation after warm-up sessions was obtained with agoniometer. Comparisons were made with analyses of variance (ANOVA) for repeated measures andpost-hoc Bonferroni (p < 0.05). Our results showed a peak torque reduction in FNP session at theconcentric phase, compared with S session at velocity 60º/s (S: 182.4 + 24.5 Nm vs. FNP: 168.5 + 27.8Nm) and B session at velocity 120º/s (B: 141.4 + 15.9 Nm vs. FNP: 129.2 + 18.4 Nm). The FNP sessionpromoted a higher range of motion variation when compared with E session. (E: 18.3 + 10.9 degrees vs.FNP: 27.9 + 6.8 degrees). We concluded that FNP stretching exercises may promote a negative effect onmaximal force of knee flexors, while static stretching exercises promotes no negative effect. However, to increase the hip ROM , the hold-relax FNP technique seems to be a better choice.