Quadriceps strength to body weight ratio is a significant indicator for initiating jogging after anterior cruciate ligament reconstruction

BACKGROUND

Quadriceps strength recovery after anterior cruciate ligament (ACL) reconstruction is an important criterion for progress in rehabilitation and return to sports. The purpose of this study was to determine whether quadriceps strength to body weight ratio (QS/BW) is a significant indicator for initiating jogging after ACL reconstruction.

METHODS

Isokinetic quadriceps strength at 60°/s was measured and a jogging trial was completed 3 months after ACL reconstruction with hamstring tendon autograft in 83 patients (36 male, 47 female; mean age, 26.6 ± 12.4 years). Based on the jogging trial results, patients were assigned to either a successful jogging group (mean velocity ≥ 9 km/h) or an unsuccessful jogging group (mean velocity < 9 km/h). The association between QS/BW and successful jogging after surgery was investigated by multivariate logistic regression analysis and the cut-off value was determined by receiver operating characteristic analysis.

RESULTS

Forty-four patients (53.0%) were assigned to the successful jogging group and 39 (47.0%) to the unsuccessful jogging group. QS/BW was independently associated with initiating jogging 3 months after surgery. The cut-off value of QS/BW for successful jogging was 1.45 Nm/kg (area under the curve = 0.94; sensitivity = 88.6%, specificity = 87.2%). All of the patients who initiated jogging with QS/BW of > 1.45 Nm/kg at 3 months returned to sports without recurrence or contralateral injury by 10 months after surgery.

CONCLUSIONS

QS/BW is a significant indicator for safely initiating jogging 3 months after ACL reconstruction. The cut-off value of QS/BW for initiating jogging was 1.45 Nm/kg.

[The tape for pulmonary artery banding]

Pulmonary artery banding remains a useful procedure for special conditions. A 3-month-old girl diagnosed as Down syndrome with atrioventricular septal defect underwent pulmonary artery banding. We used polyester tape smeared with Bone Wax for this pulmonary artery banding. After 7 months period, the tape was easily dissected from surrounding tissue and removed at radical operation. Microscopic appearance showed that the tape was intact and no evidence of inflammation or mineralization. We believe Bone Wax smeared polyester tape accomplishes well as silicone impregnated one.

[An infant with lobar emphysema requiring lobectomy after ventricular septal defect closure]

A 1-month-old male infant with respiratory distress was referred to our hospital for operation of the ventricular septal defect. A chest roentgenogram demonstrated pulmonary emphysema especially in the right upper and middle lobes. At 3 months, a perimembranous ventricular septal defect was closed. But the infant could not be weaned from the ventilator. On the 21st postoperative day, a right upper and middle bilobectomy was performed. Three days later, he was weaned from the ventilator and the postoperative course was uneventful. The pathologic diagnosis revealed no bronchial cartilagenous abnormality. Infantile lobar emphysema of the right upper lobe with congenital heart disease is rather rare. We emphasize the need for lobectomy simultaneous with, secondary to, cardiac surgery in these cases.

[Successful repair of combined cardiac rupture and septal perforation after myocardial infarction]

A 78-year-old woman was operated on with a diagnosis of oozing-type cardiac rupture after an acute anteroseptal myocardial infarction. Pericardial drainage was performed and hemostasis was obtained by dressing with local hemostatics. As hemodynamics improved, elevation of pulmonary artery pressure and a step-up in oxygen concentration in the pulmonary artery from a Swan-Ganz catheter sample appeared. A left-to-right shunt was observed in the operative field with color Doppler echocardiography and a diagnosis of ventricular septal perforation (VSP) was made. Subsequently, intracavitary repair with two sheets of equine pericardial patch, sutured using interrupted mattress sutures with felt pledgets, was performed. Her early course after operation was satisfactory in spite of a small residual shunt. However, thirty-one days later she was returned to surgery because of an increasing residual shunt. Looseness of several interrupted mattress sutures and thrombus adherent to the internal surface of the pericardial patch were observed. The thrombus was removed and the patch was reattached using both interrupted mattress sutures with felt pledgets and continuous suture. She had an uneventful recovery thereafter. As double rupture is not a rare complication after myocardial infarction, a careful hemodynamic examination is necessary and important in the diagnosis and treatment of cardiac rupture. We consider that interrupted mattress sutures are a better technique for early repair of the VSP to reduce a risk of residual shunt due to the weakness and unclear border of infarcted myocardial tissue, and continuous suture is acceptable to repair the VSP 3 to 4 weeks later after infarction. Long-term anticoagulant therapy is necessary after intracavitary repair using equine pericardial patch.

Emergency aortic arch replacement in a patient with idiopathic thrombocytopenic purpura

We herein report the case of a 56-year-old man with idiopathic thrombocytopenic purpura who required an emergency aortic arch replacement. Intraoperatively, hemostasis was achieved using platelet transfusions. Postoperatively, the use of high-dose gamma-globulin therapy was able to maintain an adequate platelet count and good hemostasis.

[Mitral valve replacement with homemade heterologous pericardial roll valve for mitral regurgitation after repair of complete atrioventricular septal defect]

Repair of using the double patch method was performed on a 6-month old child with Down's syndrome. However, at 1 year and 4 months (BW: 3.6 kg), the patient's resulting mitral regurgitation became severe and clinically unmanageable, necessitating further operation. At operation the anterior leaflet of the mitral valve was lifted up at the anterolateral side due to the patch attached to the interventricular septum, which restricted the valve from closing completely. Moreover, secondary severe hardening of the valve tissue made it difficult to reconstruct the valve. Since the diameter of the valve was only 13 mm after resection, making the impossible use of a standard prosthetic valve, we constructed a new roll valve out of a heterologous pericardium. Almost no regurgitation was observed and prognosis was favorable although a pattern of mitral stenosis was observed. The patient died 6 months later due to the worsening of respiratory infection before a reoperation could be performed. Post mortem examination revealed comparatively good valve function except mitral stenosis due to inadequate valve size. This technique has practical application for mitral valve replacement of small valve annuli of infants when other methods are not feasible.

Mitral valve replacement via right thoracotomy after coronary arterial grafting

Mitral valve replacement was performed through a right thoracotomy using femorofemoral bypass under profound systemic hypothermia in a 62-year-old man who had undergone coronary artery bypass grafting using both internal thoracic arteries. The right thoracotomy approach minimizes the risk of injury to the arterial grafts, and deep hypothermia obviates the need to interrupt the grafts to administer cardioplegia. This technique provides excellent exposure of the mitral valve while minimizing the operative risk.

[A case of octogenarian left atrial myxoma]

We reported a case of left atrial myxoma in advanced age. The case was eighty years old man. He admitted with congestive heart failure. He was diagnosed as left atrial myxoma by echocardiography. The open heart surgery was done. The myxoma was 79 g in weight and 8.5x5x3 cm in size. Post operative course was uneventful. The echocardiography is useful for diagnosis of the left atrial myxoma. The left atrial myxoma should be operated when it is diagnosed how the patient is advanced age. The septal-superior exposure gives a good operative field.

The effects of calcium antagonists and prostaglandin E1 on isolated canine coronary arterial tension

The effects of calcium antagonists (nifedipine, nicardipine, diltiazem, and verapamil) and prostaglandin E1 (PGE1) on the tension of isolated canine coronary arterial strips were studied. In a solution containing 20 mEq/L of K+, 127 mEq/L of Na+, the tension was increased by 500-1,000 mg with 4 mEq/L of Ca2+. This increase in tension was suppressed by Ca-antagonists and PGE1 dose-dependently. Nifedipine 10(-5) M, nicardipine 3 x 10(-7) M, diltiazem 3 x 10(-6) M, and verapamil 3 x 10(-6) M completely suppressed the increased tension. The maximal suppression of the tension produced by PGE1 was about 40% at 10(-10) M. In 20 mEq/L K+ solution (0 mEq/L Ca2+, 37 degrees C), the reduction of the Na+ concentrations from 127 mEq/L to 12 mEq/L increased the tension by 50 to 100 mg. This increase in tension was not suppressed by Ca-antagonists or PGE1. In conclusion, this study demonstrated that Ca-antagonists and PGE1 suppressed an increase in the tension caused by Ca2+ but did not suppress an increase in the tension caused by Na+ reduction.

Nafamostat mesilate reduces blood cell adhesion to cardiopulmonary bypass circuits: an in-vitro study

Nafamostat mesilate (FUT-175) is a protease inhibitor, working as an inactivator of coagulation, fibrinolysis and platelet aggregation. Although FUT-175 directly blocks contact factors in coagulation, it also may decrease activation of humoral cascade systems when used in cardiopulmonary bypass circuits. We performed an in vitro study using fresh human blood in the following cardiopulmonary bypass circuits: standard circuit (C), biosurfaced circuit (B) and standard circuit containing FUT-175 (F). Each circuit was primed with 500 ml of electrolyte solution and 500 ml of fresh blood. Cardiopulmonary bypass was performed using a roller pump for four hours in two sets of each circuit configuration. Platelet factors (platelet count and beta-thromboglobulin), coagulation factors (thrombin-antithrombin III complex and fibrinopeptide A), fibrinolysis factors (alpha 2-plasmin inhibitor complex and alpha 2-plasmin inhibitor), complement factors (C3a, C4a), free hemoglobin, and granulocyte elastase were measured at the beginning and end of the study. Hemocytograms were measured concurrently. The FUT-175 group showed significantly lower levels of the measured indices than the biosurfaced group in thrombin-antithrombin III complex (7.4 +/- 2.1 vs. 54.9 +/- 38.1 ng/ml), fibrinopeptide A (7.2 +/- 2.0 vs. 20.2 +/- 14.6 ng/ml), beta-thromboglobulin (1940 +/- 250 vs. 2438 +/- 314 ng/ml) and free hemoglobin (25.2 +/- 14.3 vs. 73.8 +/- 18.4 mg/dl). There were no significant differences between Group F and Group B in platelet count, C3a, C4a and granulocyte elastase, although these indices were significantly lower in Groups F and B when compared to Group C.(ABSTRACT TRUNCATED AT 250 WORDS)