Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) subcategories are affected by subjective running ability and medial single-leg hop distance in postreconstruction patients at 6 months.

Purpose: This study aimed to investigate the intricate relationship between physical function factors and each subcategory score of the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale among patients following ACL reconstruction. Methods: Participants comprised 59 patients who had undergone primary ACL reconstruction using hamstring tendon. The ACL-RSI was completed 6 months after reconstruction and five physical functions were measured in patients on the same day. Simple linear regression was performed multiple times to investigate the relationship between ACL-RSI subcategory scores as a dependent variable and each independent variable (knee strength, leg anterior reach distance, single-leg hop [SLH] distances, side bridge endurance, and subjective running ability). Multiple regression analysis was performed using a stepwise method, with factors showing a risk rate <0.05 in simple linear regression analyses as independent variables and the ACL-RSI in each subcategory score as the dependent variable. Results: Multiple regression analysis showed that subjective running ability affected all subcategories (p ≤ 0.001), and that the limb symmetry index of medial SLH distance affected both the Emotions (p = 0.047) and Confidence (p = 0.009) subcategories. Higher subjective running ability and greater limb symmetry in the medial SLH were thus positively associated with each dimension of psychological readiness. Conclusions: This study highlights the differential impact of physical function factors on specific subcategories of the ACL-RSI scale, providing clinicians with insights for designing targeted rehabilitation strategies. This original paper suggests the importance of analysing factors related to subcategory scores in addition to total ACL-RSI score, and could contribute to the understanding of determinants for a successful return to sport following ACL reconstruction. Level of Evidence: Level IV.

Factors affecting the early post-operative prognosis in morbidly obese surgical patients after laparoscopic sleeve gastrectomy - a retrospective cohort study.

BACKGROUND: The number of morbidly obese patients who have undergone bariatric surgery has been gradually increasing in Japan. These obese patients are often complicated with metabolic, cardiac, respiratory, and other diseases. The aim of this study was to analyze the perioperative clinical course in a retrospective cohort with respect to the utility of anesthesia management in order to prevent longer hospital stays after surgery. FINDINGS: Sixty-seven morbidly obese patients who had undergone sleeve gastrectomy were divided into two groups, based upon the duration of postoperative hospital stay; group S was comprised of the patients who were discharged within 5 days after surgery (n = 57) and group L was comprised of those who were discharged after 6 days or more (n = 10). The mean duration of the hospital stay was 4.8 ± 0.4 days and 7.8 ± 1.4 days in groups S and L, respectively. Multivariate logistic regression analysis showed that prolonged anesthesia was a predictor of a longer postoperative hospital stay (p < 0.05). While the difference in BMI was not significantly different, the percentage of patients with BMI ≥ 50 was 12 and 30% in groups S and L, respectively. CONCLUSIONS: Longer duration of anesthesia affected the duration of postoperative hospital stay in morbidly obese patients undergoing sleeve gastrectomy. In addition, patients with BMI ≥ 50 might be at risk of longer hospitalization after surgery.

[A case of tension pneumothorax after general anesthesia].

A 72-year-old male patient was scheduled for extirpation of the right kidney and ureter with partial resection of the bladder. Anesthesia was maintained with general and epidural anesthesia. After the end of surgery, he awoke and his spontaneous ventilation seemed to be good. Soon after extubation, he developed cyanosis and circulatory arrest. Immediately cardiopulmonary resuscitation was performed and regular beating of the heart was restored about 6 minutes after cardiac arrest. A chest x-ray showed pneumothorax on right side and he was diagnosed as tension pneumothorax caused by injury of the right diaphragmatic pleura during surgery. Pneumothorax was improved by drainage of the right thoracic cavity, and he was transferred to the intensive care unit. After 4 days of hypothermic therapy, he showed no neurological deficit and recurrence of pneumothorax was not observed. We should be aware of the occurrence of pneumothorax during perioperative period in the patients who underwent surgical procedure in the vicinity of the diaphragm.

Open-heart surgery without homologous blood transfusion in infants and children under simple deep hypothermia.

PURPOSE: To investigate the hematological changes during the perioperative period of open-heart surgery without homologous blood transfusion under simple deep hypothermia in infants and small children, and to define the limits of body weight for open-heart surgery without homologous blood transfusion under simple deep hypothermia. METHODS: We performed open-heart surgery without homologous blood transfusion under simple deep hypothermia on eight children, four infants, and a neonate with diagnoses of atrial septal defect, ventricular septal defect, on total anomalous pulmonary venous return (TATVR). All patients except for one with TAPVR were surface-cooled with ice water under deep ether anesthesia. Hematological examinations were performed seven times during the perioperative period. RESULTS: The body weight of the patients ranged from 2.5 to 15.0 kg (mean±SD, 9.5±3.5 kg) and the blood loss from 0.7 to 7.1g·kg-1 (4.6±2.0g·kg-1) The lowest values of the hematological findings in each case after surgery were as follows: Hb ranged from 7.6 to 10.9g·dl-1 (8.8±1.0g·dl-1), blood platelet count from 158×103 to 337×103 cells·µâ„“-1-agonist (271±88 ×103 cells·µâ„“-1-agonist, and total protein from 4.3 to 5.5 g·dl-1 (5.0±0.4g·dl-1) CONCLUSION: Severe anemia and hypoproteinemia were not detected in any case, and, in particular, the reduction of the platelet count was slight. No events occurred as a result of decreased Hb concentration, serum protein, or both.