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International Journal of Exercise... 2024The 'loaded carry' is a popular resistance training activity that activates core musculature across multiple movement planes while the body is in locomotion. 'Hold'...
The 'loaded carry' is a popular resistance training activity that activates core musculature across multiple movement planes while the body is in locomotion. 'Hold' exercises are similar to carry exercises but lack the locomotive aspect. Both carry and hold exercises can be completed bilaterally (farmer's carry (FC) and hold (FH)) or unilaterally (suitcase carry (SC) and hold (SH)). A deeper understanding of muscle activation between the FC and SC and intensity-matched FH and SH might improve their application. Healthy, college-aged individuals were recruited and surface electromyography of the rectus abdominis (RA), external oblique (EO), longissimus (LT), and multifidus (MF) was measured bilaterally using standard procedures. Participants completed time- and intensity-matched randomized sets of the plank, FC, SC, FH, and SH separated by 5-minute rests. A one-way ANOVA was utilized to compare exercises. The FC/FH load averaged 50.7±1.9 kg, where it was used across equally weighted dumbbells. The FC elicited higher activation bilaterally in the LT, MF, RA, and EO, compared to the FH. The SC/SH single-dumbbell load averaged 25.3±0.95 kg. There was greater activation bilaterally in the LT and MF during the SC compared to the SH. However, on the ipsilateral side of the SC, the RA and EO displayed greater activation compared to the SH, but this was not different on the contralateral side. The FC and SC were characterized by increased core muscle activation bilaterally, with the SC exhibiting unique additions to ipsilateral muscle activation.
PubMed: 38665162
DOI: No ID Found -
Saudi Journal of Anaesthesia 2024Many ultrasound-guided procedures are available for administering analgesia via peripheral nerve blockade. This systematic review aims to compare different... (Review)
Review
Many ultrasound-guided procedures are available for administering analgesia via peripheral nerve blockade. This systematic review aims to compare different ultrasound-guided procedures to determine which procedure is better suited for pediatric abdominal surgeries. The objective is to understand the efficacy of ultrasound-guided procedures for postoperative pain management in children undergoing abdominal surgeries and to identify which procedure takes less time and is better suited for a particular surgery. A systematic literature search was performed in PubMed, SCOPUS, Central Cochrane Registry of Controlled Trials (The Cochrane Library), and ScienceDirect databases for pediatric abdominal surgeries conducted with ultrasound-guided procedures for administering analgesia. We included studies involving randomized controlled trials (RCTs). Quasi-randomized controlled studies, prospective, retrospective observational studies, case series, case reports, letters, editorials, comments, animal studies, and studies from non-English literature were excluded. We reviewed 13 articles with 910 patients included. Age groups varied from 6 months to 21 years. The most common block used was the transversus abdominis block (47.76%), and the most common surgery performed was hernia and hydrocele (52.10%). Quadratus lumborum block was used in 26.92%, erector spinae block in 8.97%, modified transversus abdominus block and rectus sheath block in 9.62%, and ilioinguinal block in 6.73% of the patients. No complications were reported in any of the studies. Transversus abdominus block is less effective in two of the studies. Each procedure for pediatric postoperative analgesia has specific advantages and limitations, highlighting the complexity of tailoring interventions. Our review focuses on the advancements in ultrasound-guided analgesia for lower abdominal surgeries in pediatric patients while also emphasizing the need for future randomized controlled trials (RCTs) to compare efficacy, standardize practices, and improve patient outcomes.
PubMed: 38654876
DOI: 10.4103/sja.sja_951_23 -
Plastic and Reconstructive Surgery.... Apr 2024The upper part of the trapezius muscle attaches to the acromion and elevates the shoulder, so a defect in the trapezius muscle greatly impairs shoulder-brachial...
The upper part of the trapezius muscle attaches to the acromion and elevates the shoulder, so a defect in the trapezius muscle greatly impairs shoulder-brachial movement. We encountered a case in which the upper trapezius muscle was completely resected due to myxofibrosarcoma that occurred in the upper part of the left trapezius muscle, and reconstruction was performed using a pedicled latissimus dorsi flap with the accessory nerve transferred, resulting in favorable motor function. A 74-year-old woman developed myxofibrosarcoma in her left neck 1 year and 4 months ago, and underwent two surgical excisions at a nearby hospital. However, two months prior, she relapsed again, and was referred to our hospital, where she underwent submandibular lymph node dissection, wide tumor resection, and reconstruction using a latissimus dorsi flap. For latissimus dorsi myocutaneous flap transfer, the stump of the thoracodorsal nerve and accessory nerve were anastomosed to facilitate nerve transfer. Four months after surgery, she was able to raise her shoulder, and surface electromyography showed potentials comparable to her unaffected side. The innervated latissimus dorsi myocutaneous flap is frequently used for dynamic reconstruction of facial, brachialis, rectus abdominis, and deltoid muscles, but this is the first case report describing its use for dynamic reconstruction of the trapezius muscle.
PubMed: 38633506
DOI: 10.1097/GOX.0000000000005748 -
Orthopaedic Journal of Sports Medicine Apr 2024The epidemiology of musculoskeletal injuries at the Australian Open, Wimbledon, and US Open tennis tournaments has been investigated in recent studies; however, there is...
BACKGROUND
The epidemiology of musculoskeletal injuries at the Australian Open, Wimbledon, and US Open tennis tournaments has been investigated in recent studies; however, there is no published literature on the incidence of musculoskeletal injuries at the French Open.
PURPOSE
To describe the incidence, location, and type of musculoskeletal injuries in tennis players during the French Open tournament from 2011 to 2022.
STUDY DESIGN
Descriptive epidemiology study.
METHODS
A review was performed of all injuries documented by a multidisciplinary medical team during the French Open from 2011 to 2022. All musculoskeletal injuries that occurred during the main draw of the female and male singles or doubles matches were included. Descriptive statistics were used to summarize the data. Injury locations were grouped into regions as well as into upper limb, trunk, and lower limb.
RESULTS
In total, there were 750 injuries in 687 tennis players, resulting in a mean of 62.5 injuries per tournament; however, there were no obvious trends in injury incidence over the time frame evaluated. The number of injuries in female and male players was similar (392 vs 358, respectively). The most common injury regions were the thigh/hip/pelvis (n = 156), ankle/foot (n = 114), and spine (n = 103). The most common injury types were muscle-related (n = 244), tendon-related (n = 207), and joint-related (n = 163), and the most affected muscles were the adductors (n = 45), rectus abdominis (n = 38), and lumbar muscles (n = 25).
CONCLUSION
Over the 12-year period from 2011 to 2022 female and male players experienced similar numbers of musculoskeletal injuries, with most injuries occurring in the lower limbs compared with the upper limbs and trunk.
PubMed: 38617888
DOI: 10.1177/23259671241241551 -
Surgical Case Reports Apr 2024Pylephlebitis, a rare and lethal form of portal venous septic thrombophlebitis, often arises from infections in regions drained by the portal vein. Herein, we report a...
BACKGROUND
Pylephlebitis, a rare and lethal form of portal venous septic thrombophlebitis, often arises from infections in regions drained by the portal vein. Herein, we report a case of peritonitis with portal vein thrombosis due to acute severe appendicitis, managed with intensive intraperitoneal drainage via open abdominal management (OAM).
CASE PRESENTATION
A 19-year-old male with severe appendicitis, liver abscesses, and portal vein thrombosis developed septic shock and multi-organ failure. After emergency interventions, the patient was admitted to the intensive care unit. Antibiotic treatment based on cultures revealing multidrug-resistant Escherichia coli and Bacteroides fragilis and anticoagulation therapy (using heparin and edoxaban) was initiated. Despite continuous antibiotic therapy, the laboratory results consistently showed elevated levels of inflammatory markers. On the 13th day, open abdominal irrigation was performed for infection control. Extensive intestinal edema precluded wound closure, necessitating open-abdominal management in the intensive care unit. Anticoagulation therapy was continued, and intra-abdominal washouts were performed every 5 days. On the 34th day, wound closure was achieved using the anterior rectus abdominis sheath turnover method. The patient recovered successfully and was discharged on the 81st day.
CONCLUSIONS
Alongside appropriate antibiotic selection, early surgical drainage and OAM are invaluable. This case underscores the potential of anticoagulation therapy in facilitating safe surgical procedures.
PubMed: 38607465
DOI: 10.1186/s40792-024-01882-1 -
Gland Surgery Mar 2024Hypotonic pharmacologic lipodissolution (HPL) has gained popularity as a treatment for abdominal fat reduction, especially among Asian individuals. However, research on...
BACKGROUND
Hypotonic pharmacologic lipodissolution (HPL) has gained popularity as a treatment for abdominal fat reduction, especially among Asian individuals. However, research on the effect of HPL on abdominal vascularity and abdominal autologous tissue flap are limited.
CASE DESCRIPTION
This case report describes a patient who underwent HPL treatment in November 2022 and subsequently underwent nipple-sparing mastectomy with free transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction on April 4, 2023. The preoperative evaluation included computed tomography (CT) angiography to assess the viability of abdominal perforators and vasculature for TRAM flap reconstruction. Intraoperatively, indocyanine green (ICG) fluoroscopy was performed after TRAM flap elevation to evaluate flap perfusion. The findings revealed compromised skin-side perfusion but satisfactory deep layer perfusion, with subdermal plexus perfusion observed during de-epithelialization.
CONCLUSIONS
These findings suggest that in nipple sparing mastectomy cases with minimal skin flap preservation requirements, a history of HPL may have less negative impact on TRAM flap reconstruction. However, in skin sparing mastectomy cases with extensive skin flap preservation needs, careful assessment, including preoperative CT angiography and intraoperative ICG imaging, is essential to minimize the risk of partial flap necrosis.
PubMed: 38601296
DOI: 10.21037/gs-23-445 -
World Journal of Clinical Cases Mar 2024Malignant triton tumors (MTTs) comprise a subgroup of malignant peripheral nerve sheath tumors (MPNSTs) that exhibits rhabdomyosarcomatous differentiation and follow an...
BACKGROUND
Malignant triton tumors (MTTs) comprise a subgroup of malignant peripheral nerve sheath tumors (MPNSTs) that exhibits rhabdomyosarcomatous differentiation and follow an aggressive course. MTTs are primarily located along peripheral nerves. Cases of MTTs in the abdominal wall have not been reported. MTT has a poorer prognosis than classic MPNSTs, and accurate diagnosis necessitates a keen understanding of the clinical history and knowledge of its differential diagnosis intricacies. Treatment for MTTs mirrors that for MPNSTs and is predominantly surgical.
CASE SUMMARY
A 49-year-old woman presented with a subcutaneous mass in her lower abdominal wall and a pre-existing surgical scar that had grown slowly over 3-4 months before the consultation. She had previously undergone radical hysterectomy and concurrent chemo-radiotherapy for cervical cancer approximately 5 years prior to the consultation. Abdominal computed tomography (CT) showed a 1.3 cm midline mass in the lower abdomen with infiltration into the rectus abdominis muscle. There was no sign of metastasis (T1N0M0). An incisional biopsy identified sporadic MTT of the lower abdomen. A comprehensive surgical excision with a 3 cm margin inclusive of the peritoneum was executed. Subsequently, the general surgeon utilized an approach akin to the open peritoneal onlay mesh technique. The patient underwent additional treatment with an excision shaped as a mini-abdominoplasty for the skin defect. No complications arose, and annual follow-up CTs did not show signs of recurrence or metastasis.
CONCLUSION
An abdominal MTT was efficaciously treated with extensive excision and abdominal wall reconstruction, eliminating the need for postoperative radiotherapy.
PubMed: 38576801
DOI: 10.12998/wjcc.v12.i8.1467 -
A&A Practice Apr 2024Rectus sheath blocks can provide analgesia for upper abdominal midline incisions. These blocks can be placed on patients who are anticoagulated, supine, and under...
Rectus sheath blocks can provide analgesia for upper abdominal midline incisions. These blocks can be placed on patients who are anticoagulated, supine, and under general anesthesia. However, block success rates remain low, presumably because of the difficulty of placing local anesthetic between the correct fascial layers. Here we characterize a hypoechoic triangle with sonography, an anatomic space between adjacent rectus abdominis segments that can be accessed for easier needle tip and catheter placement. This approach could reduce reliance on hydrodissection to correctly identify the potential space and instead improve block efficacy by offering providers a discrete target for local anesthesia.
Topics: Humans; Ultrasonography, Interventional; Nerve Block; Ultrasonography; Anesthetics, Local; Rectus Abdominis
PubMed: 38572853
DOI: 10.1213/XAA.0000000000001761 -
Cureus Mar 2024Endometriosis involves the growth of endometrial-like tissue outside the uterine cavity, with its manifestation in the rectus abdominis muscle being exceptionally rare...
Endometriosis involves the growth of endometrial-like tissue outside the uterine cavity, with its manifestation in the rectus abdominis muscle being exceptionally rare and primarily observed in women with a history of abdominal surgeries. In this report, we present the case of a 42-year-old female with a medical history of two cesarean sections who presented with cyclical abdominal pain and a palpable mass in the right lower quadrant. An MRI scan of the pelvis revealed a lesion on the right lower quadrant of the abdominal wall, proximate to the previous Pfannenstiel incision. A percutaneous US-guided biopsy of the abdominal lesion was performed, and histopathology demonstrated the presence of endometrial glands and stroma, confirming the diagnosis of rectus abdominis endometriosis. She was submitted to a local wide excision with adequate margins of normal surrounding tissue and has remained free of recurrence for two years.
PubMed: 38571836
DOI: 10.7759/cureus.55462 -
Journal of Abdominal Wall Surgery : JAWS 2024In recent times there has been a surge in innovative techniques concerning complex abdominal wall surgery. The availability of simulation models for comprehensive...
In recent times there has been a surge in innovative techniques concerning complex abdominal wall surgery. The availability of simulation models for comprehensive training and skill set development remains limited. Cadaveric dissections of the porcine abdominal wall were conducted to assess the suitability of anesthetized porcine models for training in both minimally invasive and open surgical procedures. The panniculus carnosus, a typical muscular layer in mammals, is the outermost layer covering the anterolateral abdominal wall. Beneath it, there are four main pairs of abdominal wall muscles, mirroring the human anatomy. The rectus abdominis muscle runs straight along the linea alba and is surrounded by the rectus sheath, which is formed by the fusion of the lateral abdominal wall muscles and differs along the different regions of abdominal wall. The orientation of the muscle fibers in the lateral abdominal wall muscles, i.e., musculus obliquus externus, internus and transversus, is comparable to human anatomy. Although the transition lines between their muscular and aponeurotic part differ to some extent. Relevant for the adoption of surgical techniques, the transversus abdominis muscle is well-developed and resembles a bell curve shape as it transitions from its muscular to aponeurotic part. Despite minor differences in abdominal wall anatomy between pigs and humans, the porcine model provides a high level of fidelity in terms of both anatomical features and the development of skill sets relevant to hernia surgery.
PubMed: 38563043
DOI: 10.3389/jaws.2024.12359