STUDY DESIGN: Clinical audit report.
PLACE AND DURATION OF STUDY: Hospital Sultanah Aminah Johor Bahru, Malaysia, from March 2016 to May 2017.
METHODOLOGY: Data were collected retrospectively from all 127 patients who underwent CABG with saphenous vein grafts, either with CVH technique (n=68), or MIVH technique (n=59) performed with Vasoview system. The rate of wound dehiscence was evaluated. Patients with severe wound dehiscence that required readmission and surgical intervention were identified for further evaluation.
RESULTS: There was total 26.8% of wound dehiscence in our study, which was not appreciably different between two groups (p=0.092). Patient with severe wound breakdown that required surgical intervention was significantly less in MIVH group (1/59, 1.7%) compared to CVH group (8/68, 11.8%, p=0.037). There was no significant difference in readmission rate between MIVH and CVH group (p=0.574).
CONCLUSION: There is significant reduction in severity of wound dehiscence post-saphenous vein harvesting among CABG patients with MIVH technique. However, there is no statistical difference in wound dehiscence and readmission rate between MIVH and CVH technique.
CASE PRESENTATION: A 35 years old man presented with a 5 month history of debilitating painful lower limb and scrotal ulcers. This was associated with polyarthralgia and morning stiffness involving both hands. He also complained of swallowing difficulties. He had unintentional weight loss of 10 kg and fatigue. Physical examination revealed alopecia, multiple cervical lymphadenopathies, bilateral parotid gland enlargement and atrophic glossitis. There was Raynaud's phenomenon noted over both hands and generalised hyper-pigmented fragile skin. Laboratory results disclosed anaemia, leukopenia, hyponatraemia and hypocortisolism. Detailed anaemic workup revealed low serum ferritin and cobalamin level. The autoimmune screen showed positive ANA, anti SmD1, anti SS-A/Ro 52, anti SSA/Ro 60, anti U1-snRNP with low complement levels. Upper gastrointestinal endoscopy with biopsies confirmed atrophic gastritis and duodenitis. Intrinsic factor antibodies and anti-tissue transglutaminase IgA were all negative. Punch biopsies of the leg ulcer showed neutrophilic dermatosis consistent with pyoderma gangrenosum. Based on the clinical findings and positive immunologic studies, he was diagnosed as systemic lupus erythematosus. His general condition improved substantially with commencement of corticosteroids, immunosuppressants and vitamin supplements.
CONCLUSIONS: We report a case of PG as the first manifestation of SLE which was treated successfully with immunosuppressants and vitamin supplements. Our report highlighted the need to consider connective tissue diseases such as SLE in a patient presenting with PG in order for appropriate treatment to be instituted thereby achieving a good outcome.
Materials and Methods: Sixty-three diabetic foot patients admitted from June 15, 2019 to February 15, 2020. Methods included one-on-one interview for clinico-demographic data, physical examination to determine the classification. Patients were followed-up and outcomes were determined. Pearson Chi-square or Fisher's Exact determined association between clinico-demographic data, the classifications, and outcomes. The receiver operating characteristic (ROC) curve determined predictive abilities of classification systems and paired analysis compared the curves. Area Under the Receiver Operating Characteristic Curve (AUC) values used to compare the prediction accuracy. Analysis was set at 95% CI.
Results: Results showed hypertension, duration of diabetes, and ambulation status were significantly associated with major amputation. WIFi showed the highest AUC of 0.899 (p = 0.000). However, paired analysis showed AUC differences between WIFi, Wagner, and University of Texas classifications by grade were not significantly different from each other.
Conclusion: The WIFi, Wagner, and University of Texas classification systems are good predictors of major amputation with WIFi as the most predictive.
Case Description: A 66-year-old male with the right lower extremity weakness was diagnosed with a spinal dural AVF at the L1 level. It was initially treated with open surgery followed by CyberKnife radiosurgery at another institution. Five years later, he presented with a persistent pAVF fistula now involving the T11 level; the major feeder originated on the left at the T7-T8 level (e.g., involving a left-sided "duplicated" anterior spinal artery). Utilizing a three-dimensional (3D) computer tomography (CT) guided approach; he underwent a left-sided posterolateral T10-T12 laminectomy, sufficient to allow for 30-40° of anterior spinal cord rotation. This was performed under neurophysiological monitoring without any significant changes. Surgery included indocyanine green video angiography, temporary feeder clipping, and complete occlusion of the AVF, followed by complete clipping/resection as confirmed on postoperative magnetic resonance imaging.
Conclusion: Utilizing a 3D CT image, a ventral pulmonary arteriovenous malformation was excised utilizing a left-sided posterolateral approach allowing for 30-40° of cord rotation.
BACKGROUND: The back squat is an integral aspect of any resistance training program to improve athletic performance. It is also used for injury prevention of the lower limbs.
OBJECTIVE: The purpose of this study was to examine the effect of back squat training at different intensities on strength and flexibility of the hamstring muscle group (HMG).
METHODS: Twenty-two male recreational bodybuilders with at least two years of experience in resistance training were recruited to participate in a nine-week training program. They were randomly assigned to a heavy back squat group (90-95% of one repetition maximum) or a moderate-intensity back squat group (60-65% of one repetition maximum).
RESULTS: The heavy back squat group resulted in a significantly (p < 0.001) increased in one repetition maximum strength but a significant (p < 0.001) reduction in HMG flexibility when compared to their counterparts. The results of the study indicate that while a heavy back squat training program is effective in improving strength, it has an adverse effect on the flexibility of the HMG.
CONCLUSION: The implication of this study is that there is a tradeoff between strength and flexibility and trainers should select the appropriate training protocols for their athletes to maximize athletic performance.