Single-port Laparoscopic Reversal of Hartmann's Procedure: Technique and Results

In general, reversal of Hartmann's procedure is associated with a high morbidity and therefore leads to a low rate of intestinal restoration. Reversal of Hartmann's procedure has to be seen as a complex abdominal operation with the same possible complications as in other colorectal resections. By using the laparoscopic technique, operative access trauma by laparotomy can be minimized. After introducing single-port access into laparoscopic surgery beginning with cholecystectomies and sigmoid resections, we started with the first single-port laparoscopic reversal of Hartmann's procedure in January 2010. After excision of the colostoma, mobilization, and reponing into the abdominal cavity, the single-port trocar was placed at the stoma incision without any extra scar. We investigated whether the single-port laparoscopic reversal is as safely feasible as the “conventional” laparoscopic procedure. Till December 2010, single-port reversal operation was performed in 8 patients 2–4 months after Hartmann's procedure because of complicated diverticulitis. No conversion to “conventional” laparoscopic or open procedure was necessary in 1 patient one extra 5 mm trocar was used. The average operation time was 74 min. Except for one wound complication, the postoperative course was uncomplicated. The patients were discharged after 4 to 8 postoperative days. Single-port reversal of Hartmann's procedure has showed as a new method for minimizing the access trauma even further than “conventional” laparoscopic surgery

On the Distribution of Flow in a Strained Elastic Solid

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The Influence of Surface-Loading on the Flexure of Beams

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Isokinetics strength relation with fear of fall, falls and physical activity level in elderly women

Introduction: Low levels of physical activity (PA) in elderly has been related with the decline in physical and psychological functions, affecting the ability in the performance of activities of daily living (ADLs) and contributing to the occurrence of walking-related fall (Metz, Lee, Sui, Powell, Blair, 2010). The purpose of this study was to relate strength levels with fear of fall (FF), falls occurrence as well as with PA level on elderly women. Methods: One hundred not institutionalized post-menopausal women (aged 66.17 ± 8.21 years) volunteered to participate on this research. The peak torque (PT) at 60º.s-1 ( 3 rep) and 180º.s-1 (20 rep) angular speeds in knee extension and flexion concentric actions were measured using an isokinetic dynamometer (Biodex System 3). Muscular fatigue was also estimated at 180º.s-1. To achieve the occurrence of falls during last year as well FF score, we applied a standardized Questionnaire that included socio-demographic, health and falls parameters. PA level was accessed by interview with Yale Physical Activity Questionnaire. Descriptive statistics was performed using means and standard deviations. The Spearman correlation coefficient was used to investigate associations among quantitative independent variables. Results: PT at 60º.s-1 in knee extension and flexion and PT at 180º.s-1 in knee flexion showed a positive association with vigorous index (r=,205 p=,041; r=,249 p=,013; r=,218 p=,029 respectively). Standing index presented also a positive correlation with PT at 60º.s-1 and PT 180º.s-1 in knee extension (r=,205 p=,041 and r=,314 p=,004). FF registered a positive association with body mass (BM) and body mass index (BMI) (r=,205 p=,041 and r=,201 p=,045), and a negative association with PT in extension action on both angular velocities (r=-,241 p=,016 and r=-,203 p=,043). Muscular fatigue showed a positive correlation with the number of falls during the last year (r=,201 p=,036). Conclusions: Decreases of strength on lower limb is an important factor that contributes to falls occurrence once we registered a negative relation between PT on extension action and the FF. Our data related higher values of BM and BMI with higher fear of falling confirming that overweight are common associated to disturb on gait function and mobility that represents also a risk factor for falls. Present results suggest that more time of PA is needed to increase lower limb strength in the elderly

Effects of 8-Month Aquatic Training on Bone Mass Density In Post Menopausal Women With Fibromyalgia

Objective: To evaluate the effect of an aquatic training program on bone mass density (BMD) in post- menopausal women with fibromyalgia (FM). Design: Randomised controlled trial (ISRCTN53367487). Settings: Faculty of Sport Science Subjects: Twenty-four postmenopausal women with FM (mean age, 56, SD, 7 years) were randomised to intervention (n=12) or control group (n=12). Interventions: The experimental group received a supervised 8-month aquatic training consisted of three 1-hour sessions per week that included aerobic and strength exercises. Outcome Measures: The BMD of the hip area and lumbar spine was assessed by dual-energy X-ray absorptiometry technique. HRQOL was assessed using EQ-5D and the Fibromyalgia Impact Questionnaire (FIQ). Data were analysed using analysis of variance adjusted for weight and age. Results: The exercise group improved their scores for EQ-5D time trade-off utility (86%, p=.007; effect size= 0.70) and FIQ (18%, p=.005; effect size= 0.61) while the control did not. The BMD of both groups remained statistically and clinically unchanged (p> .05; effect size < 0.2). Conclusions: The aquatic training was highly effective in improving HRQOL with no adverse effects on the BMD in women with FM. The trend of bone loss was similar to that reported in non-FM untrained women. This type of rehabilitation should be complemented with exercises with higher impact on bone mass like Whole Body Vibration

Effects of aquatic exercises for women with rheumatoid arthritis: a 12-week intervention in a quasi-experimental study with pain as a mediator of depression

Background: Rheumatoid arthritis (RA) is characterized by low physical fitness, pain, and depression. The present study aimed to examine the effects of a supervised aquatic exercise program on physical fitness, depression, and pain in women with RA and determine whether decreases in pain mediate depression. Methods: Forty-three women with RA, divided into an experimental group (EG; n = 21) and a control group (CG; n = 23), participated in a 12-week exercise program. Treatment effects were calculated via standardized difference or effect size (ES) using ANCOVA adjusted for baseline values (ES, 95% confidence interval (CI)). A simple panel of mediation was executed to determine whether changes in pain mediated improvements in depression after controlling for confounding variables, such as age, physical activity, and body mass index (BMI). Results: The aquatic exercise program had trivial and small effects on physical fitness, large effects on pain, and moderate effects on depression. The mediation model confirmed the indirect effect of pain on the decrease of depression in the participants of the aquatic exercise program. Conclusions: Participants with RA in the aquatic exercise program experienced improvements in physical fitness, depression, and joint pain. Moreover, the improvements in joint pain mediated improvements in depression

Pre- and postbariatric subtypes and their predictive value for health-related outcomes measured three years after surgery

Background: Although bariatric surgery is the most effective treatment for severe obesity, a subgroup of patients shows insufficient postbariatric outcomes. Differences may at least in part result from heterogeneous patient profiles regarding reactive and regulative temperament, emotion dysregulation, and disinhibited eating. This study aims to subtype patients based on these aspects before and two years after bariatric surgery and tests the predictive value of identified subtypes for health-related outcomes three years after surgery