Relationship of lower extremity alignment during the wall squat and single-leg jump: assessment of single-leg landing using three-dimensional motion analysis.

[Purpose] The purpose of this study was to evaluate the relationship between malalignment and lower-extremity injury and to determine the optimal dynamic alignment of the lower extremity with wall squats. [Subjects and Methods] Healthy individuals from one therapy school were enrolled and assigned to a wall squat normal or abnormal group based on their forms during wall squats. The abnormal group was found to be more prone to lower-extremity injury on three-dimensional motion analysis. Eight students from each group were randomly chosen for the study. The effects of single-leg landing movements were assessed using three-dimensional motion analysis. [Results] In the sagittal plane, significant flexion of the hip and knee joints occurred 0.02 and 0.04 seconds after initial foot contact with the ground in the normal and abnormal groups, respectively. In the frontal plane, significant adduction of the hip joint occurred at 0.07 seconds in the abnormal group. [Conclusion] The abnormal group tended to display later flexion of the hip and knee joints and narrower hip, knee, and ankle range of motion than the normal group, suggesting that dynamic alignment of the lower extremity in the abnormal group likely made them susceptible to injury.

Severity scoring systems for prognosis and efficacy of polymyxin B-immobilized fiber treatment for colonic perforation.

PURPOSE: There is no established system for predicting prognosis and evaluating the efficacy of antiseptic treatments such as polymyxin B-immobilized fiber (PMX) according to the severity of peritonitis in patients with colonic perforation. We investigated the predictive value of various severity scoring systems for survival and for the efficacy of antiseptic treatments, to identify high-risk patients. METHODS: We reviewed 26 consecutive patients who underwent emergency operations between 1996 and 2003 for colorectal perforation not caused by trauma or iatrogenic disease. Several severity scores, i.e., Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), Mannheim Peritonitis Index (MPI), and Multiple Organ Failure (MOF) were calculated and analyzed as predictive scoring systems for prognosis, survival and efficacy of PMX treatment. RESULTS: An APACHE II score of 19, a SOFA score of 8, an MPI score of 30, and an MOF score of 7 or more were significantly related to a poor prognosis. With or without PMX treatment, an APACHE II score of 15 or less, a SOFA score of 7 or less, an MPI score of 27 or less, and an MOF score of 7 or less were all related to a good prognosis. Conversely, all patients died when the severity scoring points were higher than 20 in APACHE II, higher than 12 in SOFA, and higher than 39 in MPI. When PMX treatment was given to patients with an intermediate score, no correlation between survival and its efficacy was found, except in the MOF scoring system. CONCLUSION: These severity scoring systems can assist with the prediction of prognosis. They may also be useful for determining if PMX treatment would be unnecessary or ineffective in certain patients. However, the optimal application of PMX treatment in selected patients according to the severity scoring systems needs further investigation.

Prognostic factors and scoring system for survival in colonic perforation.

BACKGROUND/AIMS: No ideal and generally accepted prognostic factors and scoring systems exist to determine the prognosis of peritonitis associated with colonic perforation. This study was designed to investigate prognostic factors and evaluate the various scoring systems to allow identification of high-risk patients. METHODOLOGY: Between 1996 and 2003, excluding iatrogenic and trauma cases, 26 consecutive patients underwent emergency operations for colorectal perforation and were selected for this retrospective study. Several clinical factors were analyzed as possible predictive factors, and APACHE II, SOFA, MPI, and MOF scores were calculated. RESULTS: The overall mortality was 26.9%. Compared with the survivors, non-survivors were found more frequently in Hinchey's stage III-IV, a low preoperative marker of pH, base excess (BE), and a low postoperative marker of white blood cell count, PaO2/FiO2 ratio, and renal output (24h). According to the logistic regression model, BE was a significant independent variable. Concerning the prognostic scoring systems, an APACHE II score of 19, a SOFA score of 8, an MPI score of 30, and an MOF score of 7 or more were significantly related to poor prognosis. CONCLUSIONS: Preoperative BE and postoperative white blood cell count were reliable prognostic factors and early classification using prognostic scoring systems at specific points in the disease process are useful to improve our understanding of the problems involved.