Effects of ligandrol as a selective androgen receptor modulator in a rat model for osteoporosis.

INTRODUCTION: The selective androgen receptor modulator ligandrol (LGD-4033 or VK5211) has been shown to improve muscle tissue. In the present study, the effect of ligandrol on bone tissue was investigated in ovariectomized rat model. MATERIALS AND METHODS: Three-month-old Sprague Dawley rats were either ovariectomized (OVX, n = 60) or left intact (NON-OVX, n = 15). After 9 weeks, OVX rats were divided into four groups: untreated OVX (n = 15) group and three OVX groups (each of 15 rats) treated with ligandrol orally at doses of 0.03, 0.3, or 3 mg/kg body weight. After five weeks, lumbar vertebral bodies (L), tibiae, and femora were examined using micro-computed tomographical, biomechanical, ashing, and gene expression analyses. RESULTS: In the 3-mg ligandrol group, bone structural properties were improved (trabecular number: 38 ± 8 vs. 35 ± 7 (femur), 26 ± 7 vs. 22 ± 6 (L), 12 ± 5 vs. 6 ± 3 (tibia) and serum phosphorus levels (1.81 ± 0.17 vs.1.41 ± 0.17 mmol/l), uterus (0.43 ± 0.04 vs. 0.11 ± 0.02 g), and heart (1.13 ± 0.11 vs. 1.01 ± 0.08 g) weights were increased compared to the OVX group. Biomechanical parameters were not changed. Low and medium doses did not affect bone tissue and had fewer side effects. Body weight and food intake were not affected by ligandrol; OVX led to an increase in these parameters and worsened all bone parameters. CONCLUSION: Ligandrol at high dose showed a subtle anabolic effect on structural properties without any improvement in biomechanical properties of osteoporotic bones. Considering side effects of ligandrol at this dose, its further investigation for the therapy of postmenopausal osteoporosis should be reevaluated.

Perioperative and posttraumatic anti-edematous decongestive device-based negative pressure treatment for anti-edematous swelling treatment of the lower extremity - a prospective quality study.

BACKGROUND: The perioperative management of trauma cases and orthopedic procedures is negatively influenced by tissue swelling and edema. They delay surgical treatment, extend stay in hospital and prolong the overall time of convalescence. In case of traumatic or postoperative edema the limited transport capacity (missing muscle pump and destruction of lymphatic channels) is casual. Edema mostly results in pain, limited function of the extremity, change in shape, higher infection rate and wound disorders. Manual lymph drainage (MLD) is a treatment option with respect to the complex physical decongestion (CPD). OBJECTIVE: To evaluate whether a device-based negative pressure lymph drainage (NPLD) is capable of reducing posttraumatic and perioperative swelling of the lower extremity effectively and sustainably. METHODS: Prospective quality study submitted to the Ethics Committee. The patients only received the procedures after signing the informed consent. The negative pressure was applied locally by using LymphaTouch® device (LT) (FDA approved) with a silicone-coated applicator. The lymphatic drainage had been either applied by a local stationary manner or by using the "Lift + Twist" technique. A negative pressure has been adjusted between 50-250 mm Hg depending on the skin and tissue texture. The frequency was chosen between 90-70 Hz. Type of application: pulsed or continuous negative pressure treatment. The procedure always began in the supraclavicular fossa and continued until reaching the area of surgery in the lower extremity. Duration approx. 30 min. The patient was encouraged to drink fluids after the LymphaTouch treatment (LTT). The results were documented by measurement of the girth and movement according to neutral-zero-method (NZM) and photographs. STATISTICS: Multi-variance, Wilcoxon test non-parametric. INCLUSION CRITERIA: Patients with injury to the lower extremity (LE), elective patients, age > 18 years, signed informed consent. RESULTS: 101 patients with injuries/surgical interventions to the lower extremity, age: 64.9 ± 13.17 years. The swelling was more pronounced at the knee. After 4 treatments, there was a measurable decrease in swelling of 11.6% at the lower extremity. In patients with trauma to the hip joint or hip interventions, the swelling at the femur was reduced by 8.6% between LTT 0 vs. 4. In patients with trauma to the knee joint and surgical interventions, significantly more female patients showed a positive effect to LTT. The mobility improved substantially, while the level of pain decreased. The patients reported immediate pain relief. No complications occurred. CONCLUSION: The perioperative and posttraumatic swelling at the lower extremity can be positively affected by the LT-NPLD within the first days. The preoperative duration until surgical intervention was decreased. The postoperative stage of wound and soft tissue swelling was reduced.

Reduction of postoperative swelling with a negative pressure treatment-A prospective study.

PURPOSE: Perioperative swelling and edema are the main factors that influence the time to definitive operative care, healing rate, as well as postoperative infection rate. Device-based negative pressure treatment is a new method to reduce post-traumatic and postoperative swelling of the upper extremities. The objective of this study was to evaluate a new negative pressure treatment with LymphaTouch® (Helsinki, Finland) to reduce perioperative swelling in upper extremity injuries. METHODS: We analyzed 45 patients (26 female and 19 male) after operative treatment of upper extremity injuries. A predefined treatment algorithm of 30 min using LymphaTouch® was performed on the patients every day for five consecutive days. Swelling was measured according to the neutral-zero method with six points of measurement. RESULTS: A total of 16 patients underwent an operation on their upper arm. An average of 3.5 measurements was performed per patient, with the start of therapy at a mean of 5.13 days after the operation. All of the measured circumferences except the elbow and 10 cm below the elbow were reduced from day 0 to 3. The percent reduction of swelling (relative to day 0) was 10.36%, 11.35%, 17.34%, and 3.25% for days 1-4, respectively. The greatest reduction of circumference was obtained in the metacarpus (-51.6%) and wrist (-33.1%). CONCLUSION: The LymphaTouch® system and a 30-min treatment program can reduce postoperative swelling of the upper arm, wrist, and hand on the first 5 days after surgery. The ease of learning and self-applicability of LymphaTouch® makes it interesting for further controlled randomized trials.

[Infiltration anesthesia]. / Infiltrationsanästhesie.

OBJECTIVE: Complete anesthesia of any skin and soft tissue area by intradermal, subcutaneous, or intramuscular injections. INDICATIONS: Small injuries or incisions in limbs or trunk, minor surgery on the face/jaw (e.g., on the teeth), or postoperative analgesia (local infiltration anesthesia, LIA). CONTRAINDICATIONS: Local infections at the injection site. SURGICAL TECHNIQUE: By means of intradermal, subcutaneous or intramuscular administration, a grandeur arises, here the local anesthetic blocks nerve transmission. If anesthetized distal to end arteries, vasoconstrictors (e.g., epinephrine) should be avoided. Proximal to end arteries, localized ischemia may facilitate operative care. POSTOPERATIVE MANAGEMENT: The effect of local anesthesia is self-limiting. RESULTS: By means of infiltration anesthesia or "field block", larger areas of skin are easily accessible for surgical treatment. The amount to be applied has to be adapted to the extent of the operation and the maximal dose. Postoperatively, after knee or hip arthroplasty, analgesia consumption can be reduced, and early mobilization promoted using LIA.

[Oberst's block anesthesia]. / Leitungsanästhesie nach Oberst.

OBJECTIVE: Complete anesthesia of the phalanges of the fingers and toes. INDICATIONS: All lesions distal to the metacarpophalangeal/metatarsophalangeal joint. CONTRAINDICATIONS: Local infections at the injection site. Lesions proximal to the metacarpophalangeal/metatarsophalangeal joint. TECHNIQUE: A subcutaneous deposit of a 0.5-2% local anesthetic is administered dorsoradially and dorsoulnarly at the base of the metacarpophalangeal/metatarsophalangeal joint. With the cannula advanced to palmar, an additional 0.5-1.5 ml is then administered to achieve complete anesthesia. POSTOPERATIVE MANAGEMENT: The effect of the local anesthesia is self-limiting. RESULTS: The Oberst block results in reliable anesthesia of the finger and toe. All surgical procedures distal to the metacarpophalangeal/metatarsophalangeal joint can be performed without pain.