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Gait abnormalities such as Trendelenburg gait (TG) in patients who have hip osteoarthritis (OA) have traditionally been evaluated using clinicians' visual assessment. Recent advances in portable inertial gait sensors offer more sensitive, quantitative methods for gait assessment in clinical settings. This study sought to compare sensor-derived metrics in a cohort of hip OA patients when stratified by clinical TG severity. There were 42 patients who had hip OA and were grouped by TG severity (mild, moderate, and severe) through visual assessment by a single arthroplasty surgeon who had > 30 years of experience. After informed consent, wireless inertial sensors placed at the midpoint of the intercristal line collected gait parameters including pelvic shift, support time, toe-off symmetry, impact, and cadence. Clinical data on hip strength, range of motion, and Kellgren-Lawrence grade were collected. Worsening TG severity had a higher mean Kellgren-Lawrence grade (2.5 versus 3.2 versus 3.4; P =.014) and reduced passive hip abduction (P =.004). Severe TG group demonstrated predominantly contralateral pelvic shift (n = 9 of 10, 90.0%), while ipsilateral shift was more frequently detected in moderate (n = 10 of 18, 55.6%) and mild groups (n = 9 of 14, 64.3%; P =.021). Contralateral single support time bias was greatest in severe TG (35.7% versus 50.0 versus 90.0%; P =.027). Asymmetric toe-off, impact, and support times were observed in all groups. Traditional understanding of TG is that truncal shift occurs to the ipsilateral side. Using sensor-based measurements, the present study demonstrates a shift of the weight-bearing axis toward the contralateral side with increasing TG severity, which has not been previously described. Inertial sensors are feasible, quantitative gait measuring tools, and may reveal subtle patterns not readily discernible by traditional methods. [ABSTRACT FROM AUTHOR]

Trendelenburg gait describes contralateral pelvic drop during single leg stance (SLS) with occasional lateral trunk lean compensation over the stance limb. However, quantitative research on 'uncompensated Trendelenburg' gait (pelvic drop independent of lateral trunk lean) remains sparse among populations that commonly utilize this gait pattern, such as adolescent hip pathology patients. How prevalent is uncompensated Trendelenburg among various adolescent hip pathologies and how is it related to hip load, hip abduction strength, and self-reported hip pain? Gait, strength, and pain data were collected among 152 pre-operative patients clinically diagnosed with acetabular hip dysplasia, femoroacetabular impingement, Legg-Calvé-Perthes, or slipped capital femoral epiphysis (SCFE). Patients with ≥ 5.4° of dynamic pelvic drop in SLS were divided into a 'pelvic drop' group and screened to exclude those with excessive ipsilateral trunk lean. They were then compared to the 'stable pelvis' patients using a Mann-Whitney test. Dysplasia patients represented the highest proportion of the pelvic drop group (46%). The pelvic drop group showed a significant increase in self-reported hip pain (p = 0.011), maximum hip abductor moment (p = 0.002), and peak coronal power absorption at the affected hip during SLS loading response, (p < 0.001) while showing no difference in abduction strength (p = 0.381). Uncompensated Trendelenburg gait may lead to increased loading of the affected hip in adolescent hip pathology patients. Disadvantageous hip biomechanics can create increased abductor muscle demand among these pathological populations, with dysplasia patients showing the highest prevalence. Maximal abduction strength did not correlate with pelvic drop. Future work should aim to identify and quantify causal factors. Increased coronal hip power absorption during weight acceptance warrants clinical attention, as there may be a detrimental, over-reliance on passive hip structures to support load among a population that that is already predisposed to hip osteoarthritis. • Excessive pelvic drop in gait can be exhibited by adolescents with hip disorders. • Without a trunk lean compensation, this gait increases load at the affected hip. • Abnormal hip morphology may create mechanical disadvantages that cannot be overcome. • There may be an over-reliance on passive hip structures to support load. • In populations predisposed to hip osteoarthritis, clinical awareness is warranted. [ABSTRACT FROM AUTHOR]

Abstract Background Patients with chronic low back pain may present changes in hip muscles. However, there is still limited and controversial evidence of the association between hip muscle weakness and chronic low back pain and whether this weakness can be assessed with functional tests. The purpose of this study was to assess whether there is hip muscle weakness in patients with non-specific chronic low back pain and whether there is an association between the positive Trendelenburg and Step-Down tests and hip muscle strength. Methods This cross-sectional study included 40 patients with chronic low back pain and 40 healthy participants, assessed in an outpatient clinic in Vitória, Espírito Santo, Brazil. Muscle strength was measured for the hip abductors, adductors, extensors, internal rotators, and external rotators using isometric manual dynamometry and functional stability was measured by the Trendelenburg and Step-Down tests. Muscle strength was compared using the t test for independent samples and the chi-square test. The association between the tests and strength was performed using a binary logistic regression analysis. Results Healthy participants showed a statistically significant greater muscle strength for the right hip abductors (mean difference [MD]: 28.1%, 95% confidence interval [CI]: 9.4 to 46.9), right adductors (MD: 18.7%, 95% CI: 6.2 to 31.2), right internal rotators (MD: 8.7%, 95% CI: 1.5 to 15.8), right extensors (MD: 21.1%, 95% CI: 6.2 to 31.2), left abductors (MD: 30.4%, 95% CI: 11.9 to 49), left adductors (MD: 18.4%, 95% CI: 3.7 to 33.2), and left extensors (MD: 21.6%, 95% CI: 6.6 to 36.5). There was no difference between groups for the positive functional tests, and there was no association between the tests and hip muscle strength. Conclusion Patients with chronic low back pain tend to have hip abductors, adductors, and extensors weakness. Furthermore, the functional tests should not be associated to hip muscle strength in patients with chronic low back pain.

This paper provides a reconstruction and analysis of Marx’s early engagements with logic, and especially his studies of Hegel’s logic, on the one hand, and Hegel’s great if often overlooked critic Adolf Trendelenburg, on the other. It itemises the archival evidence that Marx read and planned to compose a Hegelian response to Trendelenburg’s devastating attack on dialectics in his 1840 Logische Untersuchungen – the work that arguably did more than any other single text to destroy the influence of Hegelianism among German intellectuals at the time. It argues that the young Marx was a more sophisticated reader of Hegel and of philosophy in general than is typically acknowledged. Against the backdrop of these claims, it then proposes a new reading of Marx’s work from 1839 to 1842 – one that takes the emphasis off the familiar distinction between materialism and idealism, which was as much an invention of Engels’s later interpretations of the early Marx as it was an invention of Marx himself, and places it instead on what early nineteenth-century thinkers would have understood to be the more comprehensive question of logic. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic low back pain may present changes in hip muscles. However, there is still limited and controversial evidence of the association between hip muscle weakness and chronic low back pain and whether this weakness can be assessed with functional tests. The purpose of this study was to assess whether there is hip muscle weakness in patients with non-specific chronic low back pain and whether there is an association between the positive Trendelenburg and Step-Down tests and hip muscle strength. Methods: This cross-sectional study included 40 patients with chronic low back pain and 40 healthy participants, assessed in an outpatient clinic in Vitória, Espírito Santo, Brazil. Muscle strength was measured for the hip abductors, adductors, extensors, internal rotators, and external rotators using isometric manual dynamometry and functional stability was measured by the Trendelenburg and Step-Down tests. Muscle strength was compared using the t test for independent samples and the chi-square test. The association between the tests and strength was performed using a binary logistic regression analysis. Results: Healthy participants showed a statistically significant greater muscle strength for the right hip abductors (mean difference [MD]: 28.1%, 95% confidence interval [CI]: 9.4 to 46.9), right adductors (MD: 18.7%, 95% CI: 6.2 to 31.2), right internal rotators (MD: 8.7%, 95% CI: 1.5 to 15.8), right extensors (MD: 21.1%, 95% CI: 6.2 to 31.2), left abductors (MD: 30.4%, 95% CI: 11.9 to 49), left adductors (MD: 18.4%, 95% CI: 3.7 to 33.2), and left extensors (MD: 21.6%, 95% CI: 6.6 to 36.5). There was no difference between groups for the positive functional tests, and there was no association between the tests and hip muscle strength. Conclusion: Patients with chronic low back pain tend to have hip abductors, adductors, and extensors weakness. Furthermore, the functional tests should not be associated to hip muscle strength in patients with chronic low back pain. [ABSTRACT FROM AUTHOR]

Viktor D. Kudryavtsev-Platonov is one of the most prominent representatives of Russian religious-academic philosophy of the second half of the nineteenth century whose theory of cognition bears an imprint of the Kantian theoretical philosophy. Kudryavtsev was not only thoroughly familiar with the Königsberg thinker’s work, but offered a critically reinterpreted version of Kant’s teaching on space, time and categories of understanding. But was the Russian philosopher original in his reading and critique of Kant? In his later works Kudryavtsev often cites the works of Friedrich Adolf Trendelenburg whose works turn out to be very close to the Russian philosopher. Could it be that Kudryavtsev read Kant through Trendelenburg’s optics? To answer this question consistently I give outlines of Trendelenburg’s and Kudryavtsev’s theories of cognition and compare their views on the basis of the sources. I then draw on archive materials to characterise Kudryavtsev’s acquaintance with the works of Kant and Trendelenburg. It turns out that Kudryavtsev was well-versed in Kant’s philosophical ideas already in the early years of his teaching activities — but not from primary sources, but largely through German historical-philosophical renderings. I establish similarities between the teachings of Trendelenburg and Kudryavtsev on space, time and the categories of understanding and their critique of the relevant Kantian teaching. Finally, Kudryavtsev’s early manuscripts attest to his acquaintance with Trendelenburg’s ideas. I conclude that Trendelenburg influenced Kudryavtsev’s own theory of cognition, a fact that should be borne in mind when reading the Russian philosopher’s epistemological works.

In the first Critique, Kant raises two objections against Aristotle’s categories. Kant’s concern, in the first instance, is whether Aristotle generated all categories that there are and if he did not generate any spurious categories. However, for Kant, this is only a symptom of the second – deeper – flaw in Aristotle’s thinking. According to Kant, Aristotle generated his categories ‘on no common principle.’ This paper develops the two Kantian objections, offers an overview of Brentano's (1862. Von der Mannigfachen Bedeutung des Seienden nach Aristoteles. Freiburg im Brisgau: Herder’sche Verlagshandlung.) reconstruction of Aristotle’s categories (which claims to have addressed them), develops three objections to this reconstruction, and recommends (Trendelenburg, A. 1846. Geschichte der Kategorienlehre. Berlin: Verlag von G. Bethge.) as a better – albeit still flawed – Aristotelian reply to Kant. [ABSTRACT FROM AUTHOR]

The clinical utility of the Trendelenburg Test remains unknown in people with multiple sclerosis (MS). To measure (1) intra-rater reliability, (2) agreement of goniometer-assessed Trendelenburg pelvis-on-femur angle (POF) with motion capture, and (3) concurrent validity of Trendelenburg POF and hip abduction strength with POF during walking and step negotiation. Trendelenburg POF was measured in 20 people with MS using goniometry and motion analysis. In addition, peak POF was measured using motion analysis during walking, step ascent, and step descent. Intra-rater reliability of goniometer-assessed Trendelenburg POF and agreement with motion analysis-assessed POF were analyzed. Pearson's r was used to determine the relationships between Trendelenburg POF and hip abduction strength with peak POF during each functional activity. Goniometer-assessed Trendelenburg POF demonstrated very strong reliability (ICC: 0.948), strong agreement with 3D motion analysis (ICC: 0.792), correlated moderately with peak POF during walking (r = 0.519) and step ascent (r = 0.572), and weakly with step descent (r = 0.463). Hip abductor strength correlated weakly with peak POF during step ascent (r = −0.307) and negligibly during walking (r = −0.270) and step descent (r = −0.249). Goniometer-assessed Trendelenburg POF was reliable, agreed with motion analysis, and may provide insight into hip abduction muscle performance during functional activities in people with MS. [ABSTRACT FROM AUTHOR]

The aim of this historical vignette is to analyze the role of Friedrich Trendelenburg's tracheal balloon cannula in the development of laryngeal surgery in the early 1870s. The purpose of this cannula was to prevent bleeding into the airway in cases of extensive laryngeal surgery requiring a tracheostomy. [ABSTRACT FROM AUTHOR]

Frege famously claimed that variations in the sense of a proper name can sometimes be 'tolerated'. In this paper, we offer a novel explanation of this puzzling claim. Frege, we argue, follows Trendelenburg in holding that we think in language—sometimes individually and sometimes together. Variations in sense can be tolerated in just those cases where we are using language to coordinate our actions but are not engaged in thinking together about an issue. [ABSTRACT FROM AUTHOR]

Robotic gynecologic surgery is associated with the use of steep Trendelenburg positioning. Steep Trendelenburg is necessary to provide optimal exposure to the pelvis but is associated with an increased risk of non-surgical complications such as suboptimal ventilation, facial and laryngeal edema, increased intraocular and intracranial pressure as well as neurologic injury. Several case reports have described otorrhagia after robotic assisted surgery; however, there are limited reports on the risk of tympanic membrane perforation. To our knowledge, there are no published reports on tympanic membrane perforation in gynecologic nor gynecologic oncology surgery. We report two cases of perioperative tympanic membrane rupture and bloody otorrhagia associated with robot-assisted gynecologic surgery. In both cases otolaryngology/Ear Nose and Throat (ENT) was consulted, and the perforations resolved with conservative management.

This article examines Marx's earliest writings, especially his doctoral dissertation on "The Difference Between the Democritean and Epicurean Philosophy of Nature" and the notebooks he kept while preparing it. Previous commentators on this material have tended to take one of two approaches: either they have used it to associate Marx with an expansive and abstract Western Tradition of philosophical inquiry, or they have located it in the narrow context of the intellectual culture of the German Vormärz. Here I seek to mediate between these extremes. These documents, I argue, suggest that Marx was less a part of a Western Tradition, or a set of abstract normative debates that ostensibly stretches from the ancients to modernity, than of what I call Latin Culture, or a Latin-speaking culture that was inscribed in practices, norms, and institutions, and that persisted in Europe from late antiquity into the nineteenth century. Placing Marx's early writings in this context helps explain some of the tensions that characterise his thought and to clarify the practical consequences of what might otherwise appear as purely theological and metaphysical speculations. [ABSTRACT FROM AUTHOR]

Anaesthesia for robotic surgeries done in steep trendelenburg position are associated with risks such as facial oedema, conjunctival chemosis, raised intraocular pressure, laryngeal oedema, and delayed awakening. We proposed the use of the cuff leak test in them to record the frequency of laryngeal oedema at the end of surgery and attempted to find its correlation with probable risk factors. We conducted a prospective observational study of 100 patients aiming primarily to assess the frequency of positive cuff leak test in robotic abdominal surgeries performed in trendelenburg position. The secondary outcomes were to check its correlation with intravenous fluid administration, duration of pneumoperitoneum, and angle of trendelenburg position. We also recorded the frequency of chemosis, the frequency of post-extubation stridor in 24 h post-operatively, and the frequency of reintubation. Out of 100 participants undergoing elective abdominal robotic surgery in trendelenburg position, ninety were analysed. Total 31.6% (n = 30) participants showed positive cuff leak test. Chemosis was observed in 31 (32.6%) participants. No patient experienced post-extubation stridor or required reintubation during post-operative follow up. There was a no correlation between cuff leak test and intravenous fluid, duration of pneumo-peritoneum, or with angle of trendelenburg. The frequency of positive cuff leak test was high in patients at the end of robotic surgery but none of these patients had post-extubation stridor or required reintubations. There was no correlation with the fluid, angle, or duration of surgery. Clinical Trials Registry of India (CTRI/2017/04/008289), ctri.nic.in. [ABSTRACT FROM AUTHOR]

Introduction: Paradoxical brain herniation (PBH) represents a rare and potentially life-threatening complication observed in individuals following decompressive craniectomy. Its diagnosis necessitates a high level of suspicion, combined with clinical and imaging evidence, such as midline shift, herniation, and a decreased Glasgow Coma Scale (GCS). Given the rarity and severity of this condition, we conduct a comprehensive literature review to identify all documented predisposing factors, clinical presentations, and appropriate clinical management. This review will serve as a guide for effective treatment strategies., Case Presentation: In this report, we document three cases of post-traumatic PBH following decompressive craniectomy. The patient's predisposing factor was a lumbar puncture, with two cases resolving after Terendlenburg repositioning, hydration, and elective cranioplasty. The third case developed PBH after external ventricular drainage (EVD) insertion. Although the patient's GCS improved after clamping the EVD and hydration, the patient ultimately succumbed to meningitis., Clinical Discussion: The primary clinical manifestations of PBH often encompass a diminished GCS alongside radiographic evidence of midline shift and brain herniation. Various precipitating factors have been associated with PBH after decompressive craniectomy, including CSF drainage, dehydration, and upright positioning, although instances of spontaneous PBH have been documented. Reported therapeutic strategies encompass rehydration, Trendelenburg positioning, temporary cessation of CSF drainage, and cranioplasty., Conclusion: Given the infrequency of PBH and the potential for misdiagnosis with brain edema, it is imperative to consider this condition in every patient who experiences a decreased level of consciousness following decompressive craniectomy., Competing Interests: Declaration of competing interest All authors declare no conflict of interests., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: Transfer of the gluteus maximus with refixation at the greater trochanter for treatment of abductor deficiency., Indications: Symptomatic abductor deficiency with atrophy and fatty degeneration of the gluteal muscles > 50% (grade 3 by quartile) with good strength of the gluteus maximus., Contraindications: Low atrophy or fatty degeneration of less than 50% of the gluteal muscles, limited strength of the gluteus maximus, infection., Surgical Technique: First, the fascia lata is incised dorsally to the tensor fascia latae muscle, with the incision extending approximately 1.5 cm proximal to the iliac crest. A second incision divides the gluteus maximus muscle longitudinally along the muscle fibers and continues towards the fascia lata distal to the greater trochanter. These incisions result in a triangular muscle flap, which is elevated and divided into anterior and posterior portions. The posterior flap is positioned ventrally over the femoral neck and fixed to the anterior capsule and the anterior edge of the greater trochanter. The anterior flap is placed directly on the proximal femur. For this purpose, a groove is prepared in the area of the proximal femur using a spherical burr to freshen up the future footprint. The anterior flap is positioned from the tip of the greater trochanter towards the insertion of the vastus lateralis muscle. Subsequently, the anterior flap is fixed to the created groove with transosseous sutures and positioned under the elevated vastus lateralis muscle in 15° abduction of the leg. To provide additional stabilization to the tendinous part of the anterior flap, a screw is inserted distally to the greater trochanter. The vastus lateralis muscle is attached to the distal tip of the anterior flap, and the remaining gluteus maximus muscle is sutured to the fascia lata to cover the anterior flap. Additionally, a flap of the tensor fascia latae muscle can be mobilized and adapted to the reconstruction. Layered wound closure is performed., Results: The technique of a gluteus maximus transfer represents a method for the treatment of chronic abductor deficiencies and improves abduction function as well as the gait pattern in short-term follow-ups. Fifteen patients (mean age at time of surgery 62 years) had after a mean follow-up of 2.5 years. The modified Harris Hip Score (mHHS) improved from 48 points preoperatively to 60 points at follow-up. Preoperatively, 100% had a positive Trendelenburg sign; at follow-up, this was about 50%., (© 2024. The Author(s).)

Abstract Background One of the most controversial aspects for maximizing outcomes after total hip arthroplasty (THA) remains the surgical approach to the hip joint. The posterior (PA) and lateral approaches (LA) are the two most commonly performed approaches used worldwide, but sparse data are available for their comparison in terms of health-related quality-of-life (HRQoL). The aim of this study was to assess the role of the PA and LA in the HRQoL and hip functionality of patients who underwent primary and elective THA for osteoarthritis, after a minimum 2-year follow-up. Methods One hundred twenty-eight patients (140 THAs: 68 with PA and 72 with LA) were evaluated in a matched cohort study. Data gathered included the body mass index, the American Society of Anesthesiologists score, surgery time, serum creatine phosphokinase (CpK) levels, estimated intraoperative blood loss and intra- or postoperative complications. Preoperatively and at the last follow-up, the activities of daily living, and the instrumental activities of daily living (IADL) scales, the Western Ontario and Mac Master University (WOMAC) Questionnaire, the Harris Hip Score (HHS) and the Visual Analogue Scale (VAS) were used to assess HRQoL and functionality. The Short Form-36 Health Survey (SF-36) Questionnaire was administered at the last follow-up. Results Postoperatively, CpK was higher in the LA group compared to the PA (695 ± 648 vs. 447 ± 326 UI/L, p

Background: Laparoscopic removal of cryptorchid testes has been routinely reported through enlarged parainguinal incisions in dorsally recumbent horses. Outcomes following removal through an extended umbilical incision have not been previously reported. Objective: To describe the surgical technique of removing cryptorchid testes in dorsally recumbent horses through an enlarged umbilical portal after laparoscopic intra‐abdominal castration. Study design: Retrospective case series. Methods: Medical records were reviewed for horses that underwent laparoscopic removal of unilateral or bilateral cryptorchid testes from January 2006 to December 2016. Horses were placed under general anaesthesia, positioned in dorsal recumbency and then tilted into Trendelenburg position. Cryptorchid testes were castrated by ligating loop application and/or electrosurgery. The umbilical portal incision was extended along the linea alba for testes removal. All descended testes were removed by routine closed castration with the scrotal incision left to heal by second intention. Perianaesthetic laboratory values, surgical procedure descriptions, surgery and anaesthesia times, and in‐hospital perioperative complications were recorded. Results: A total of 79 horses, aged 1‐14 years, with unilateral or bilateral cryptorchidism were included: 90 cryptorchid testes were successfully removed through an enlarged umbilical portal incision. Sixty‐eight horses were unilaterally cryptorchid and 11 were bilaterally cryptorchid. Two horses had minor post‐operative complications related to the extended umbilical portal incision. Main limitations: Retrospective nature of the study, no control population for comparison and no follow‐up after hospital discharge. Conclusion: An extended umbilical portal incision is a successful alternative to extending a parainguinal incision for testis removal after laparoscopic castration. [ABSTRACT FROM AUTHOR]

Robot-assisted surgeries are associated with steep positions which provide free operative field to surgeons; however, it becomes more challenging to the anaesthesiologists. In robot-assisted surgery, the patient is not usually accessible after docking in of robot, so monitors, circuits and tubes should be tightly secured and confirmed before handing over the patient to the surgeons. We report a patient with partial left axillary artery occlusion in a patient posted for robot-assisted radical cystectomy.

This study was conducted to investigate the influence of body position on respiratory compliance and oxygenation during iatrogenic pneumoperitoneum in the rabbit. The peak inspiratory pressure, dynamic compliance, static compliance and arterial gas parameters were calculated and measured 10 min before and 30 min after the creation of pneumoperitoneum with the patient in the horizontal position, 30 min after placing the patient in the Trendelenburg position and 30 min after placing the patient in the reversed Trendelenburg position. Following the creation of pneumoperitoneum and Trendelenburg positioning, there was a significant increase in peak inspiratory pressure while dynamic and static respiratory compliance decreased. Similarly, arterial oxygenation increased during Trendelenburg position while arterial carbon pressure remained within limits during all positions. Overall, the reverse Trendelenburg position did not improve ventilation, neither the oxygenation. However, this position showed to be more appropriate because may reduce the risk of lung injury associated with high-pressure ventilation during pneumoperitoneum.

Ramosetron, often used to prevent postoperative nausea and vomiting, might cause heart-rate-corrected (QTc) interval prolongation, as might robot-assisted laparoscopic prostatectomy (RALP), which requires a steep Trendelenburg position and CO2 pneumoperitoneum. This study aimed to determine how ramosetron administration affects the QTc interval in patients treated with RALP. Fifty-six subjects were randomly assigned to ramosetron (n = 28) or control (n = 28) groups. The ramosetron group received 0.3 mg of ramosetron after anesthetic induction, whereas the control group received normal saline. The QTc interval was measured before and after induction; after 5, 30, and 60 min of being placed in the Trendelenburg position; immediately after being returned to a supine position; and at the end of surgery. Linear mixed models were used to compare QT intervals between groups. QTc intervals did not differ significantly between groups over time (Pgroup×time = 0.111). However, they increased significantly in both groups after placement in the Trendelenburg position compared with before induction (Ptime < 0.001). This increase in QTc continued until the end of surgery in both groups. Based on these findings, ramosetron can be safely administered for the prevention of postoperative nausea and vomiting among patients undergoing RALP. [ABSTRACT FROM AUTHOR]

Objective: The aim of this research was to assess the effectiveness of antislip surfaces for reducing intraoperative patient displacement while in the Trendelenburg position. Materials and Methods: A prospective randomized trial was conducted on intraoperative displacement in patients undergoing major laparoscopic or vaginal gynecologic surgery from June 2018 to December 2019. Patients were randomly assigned to 1 of 3 antislip surfaces: pink pad (The Pink Pad XL®; Xodus Medical Inc., New Kensington, PA), gel pad (Action® O.R. Overlay; Action Products Inc., Hagerstown, MD), or beanbag (Olympic Vac-Pac®; Natus Medical Inc., Pleasanton, CA). A total of 161 patients were enrolled, with 148 eligible for analysis. The primary outcome was intraoperative displacement related to the Trendelenburg position. This was assessed by measuring movement at the perineum, anterior superior iliac spine (ASIS), umbilicus, acromion, and head. Secondary measures also assessed included positioning time, postoperative pain, and erythema. A sample size of 50 patients per arm could achieve a >90% power. Results: There was significantly less movement on the pink pad at all anatomical landmarks, compared to the gel pad (p ≤ 0.001). The beanbag was equivalent to the pink pad, except at the ASIS (p = 0.008) and perineum (p = 0.022), where it had greater displacement. The most-consistent predictors of movement included: height; weight; and body mass distribution. Obese patients' displacement was 32%–55% greater than the nonobese patients' displacement. The pink pad was 19.2% (p = 0.042) and 30.8% (p < 0.001) faster to position than the gel pad and beanbag, respectively. Postoperative back pain was less on the pink pad, compared to the gel pad (p = 0.036). Postoperative erythema was significantly less common on the pink pad versus the beanbag (6.2% versus 30%, respectively; p = 0.005). There were no differences in complications among the antislip surfaces. Conclusions: Patients on the pink pad had significantly less displacement with Trendelenburg and faster positioning, compared to the gel pad. Obesity is a major predictor of movement. The pink pad was associated with less postoperative pain than the gel pad and less postoperative erythema than the beanbag. (J GYNECOL SURG 38:153) [ABSTRACT FROM AUTHOR]

Summary: Equine anaesthesia is associated with a high risk of perioperative morbidity and mortality, particularly in the recovery period. Cardiovascular collapse and cardiopulmonary arrest (CPA) have been reported to account for one‐third of anaesthesia‐related perioperative deaths in the horse. This case report describes the successful cardiopulmonary resuscitation of a healthy adult Thoroughbred mare that developed cardiovascular collapse and subsequent CPA following positioning in the recovery box after general anaesthesia in the Trendelenburg position. Cardiopulmonary resuscitation (CPR) was instigated and included thoracic compressions, intermittent positive pressure ventilation and adrenaline administered via the intravenous and intra‐tracheal routes. Return of spontaneous circulation (ROSC) was detected 5 min and 50 s after the start of CPR. A stable stance was achieved approximately 100 min after ROSC. The mare was discharged from the hospital 3 days later with no known complications. To the authors' knowledge, this is the first case report documenting CPA following general anaesthesia in the Trendelenburg position in a horse, with subsequent successful CPR. The precise cause of the CPA is unknown but a number of plausible hypothesis are discussed including hypoventilation and a Bezold‐Jarisch reflex. [ABSTRACT FROM AUTHOR]

Background and Aims: There is a wide variation in the anatomical relationship of the Internal Jugular Vein (IJV) to the Common Carotid Artery (CCA). This makes landmark based techniques of IJV cannulation and head rotation questionable and may lead to accidental arterial puncture. We conducted this study to determine the anatomical relation of the IJV to the CCA using (USG) in patients undergoing IJV cannulation for central venous access, and to analyse the effect of head rotation on this relationship. Material and Methods: A prospective observational study was conducted on 100 patients requiring central venous access, in the operation theatre or the intensive care unit. Anatomical relationship of the IJV to CCA at the level of the cricoid cartilage was analysed by noting the segment position (1-12) around the CCA using a high frequency linear USG probe on patients in neutral head position, on both sides and also with the head rotated to the contra lateral side by 15° and 45°. Results: Antero-lateral segments 1 and 2 were the most common positions (50% on the right and 73% on the left side). Change in segment causing increase in overlap of IJV and CCA with 15° head rotation was seen in 44% subjects on the right and 39% on the left. Statistically, a higher number of subjects showed overlap with 45° rotation (99% on right and 97% on left, P < 0.05). Conclusion: There is a wide variation in anatomical location of the IJV in relation to the CCA as seen by USG. Excessive head rotation causes overlap of IJV over CCA which may cause inadvertent arterial puncture, even under USG guidance. Thus, it is preferable to cannulate the IJV in neutral or near neutral head and neck position.

Background: Despite experiencing pain relief and improved activities of daily living after total hip arthroplasty (THA) for osteoarthritis of the hip, a Trendelenburg gait may be observed in some patients. The concentric and eccentric contraction patterns of hip muscles in a Trendelenburg gait are not well understood., Methods: This study included 89 patients (28 males and 61 females, mean age 66.5 ± 8.4 years, mean postoperative period 1.3 ± 0.4 years) after unilateral THA without functional impairment on the contralateral side. Gait analysis utilized a three-dimensional motion capture system to assess pelvis and hip angles, hip moment, and hip power. A Trendelenburg gait was defined as positive when nonoperative pelvic descent occurred at 30 % of the gait cycle, equivalent to mid-stance. Patients were classified into Trendelenburg gait-positive and -negative groups for statistical analysis. Unpaired t -test and chi-square test were used to compare the two groups. Multiple regression analysis was conducted to identify factors associated with the presence of a Trendelenburg gait., Results: A Trendelenburg gait was observed in 24 patients (27 %). Multiple regression analysis indicated that abduction (p < 0.01) and extension (p = 0.03) of hip joint power were significant determining of a Trendelenburg gait. Patients with a Trendelenburg gait exhibited reduced eccentric contraction of the hip abductor muscles and decreased concentric contraction of hip extensor muscles during early to mid-stance of their gait., Conclusion: Centrifugal contraction of hip abductor muscles and diminished eccentric contractility of hip extensor muscles appear crucial for hip stabilization mechanisms during gait after THA., Competing Interests: None., (© 2024 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Background: Despite promising results at the mid-term followup, several aspects of conversion of the fused hip to total hip arthroplasty (THA) remain controversial. The aim of this study was to evaluate clinical and radiological outcomes with a minimum 5-year followup in patients who underwent conversion of the fused hip to THA.Methods: Fifty-seven patients (59 hips) were evaluated. The Harris Hip Score (HHS), range of motion (ROM), and the Visual Analogue Scale (VAS) were used to assess hip function and low back pain. Subjective satisfaction with surgery and the presence of the Trendelenburg sign was also evaluated. Radiological assessment was performed pre- and postoperatively to evaluate loosening and heterotopic ossification (HO).Results: After a mean followup of 13.0 ± 6.2 years, HHS and VAS significantly improved from 46.0 ± 16.7 to 80.8 ± 18.8 and from 4.4 ± 1.5 to 2.1 ± 1.4 (both P < .001), respectively. Twenty-three patients (40.4%) had a positive Trendelenburg sign, and HOs were found in 29 cases (49.1%). An overall 29.8% complication rate was noted. Smoking habits and rheumatoid arthritis were predictive of Trendelenburg sign (P = .046 and P = .038, respectively). Implant survival rate as the end point was 98.7 ± 1.3% at 5 years, 92.4 ± 3.3% at 10 years, 82.1 ± 5.7% at 15 years, and 73.4 ± 8.0% at 20 and 25 years. A worse cumulative implant survival rate was noted in patients who underwent previous hip surgery, defined as any hip operation before fusion (P = .005).Conclusion: Conversion of the fused hip to hip arthroplasty provides high levels of hip functionality and satisfaction with surgery at long-term followup. An implant survival rate higher than 70% can be expected 25 years postoperatively. [ABSTRACT FROM AUTHOR]

Background: Patients with acute respiratory distress syndrome (ARDS) are generally ventilated in either 45° head elevation or prone position as they are associated with decreased incidence of ventilator-associated pneumonia and mortality, respectively. But in patients with poor lung compliance and super-added diaphragmatic weakness/dysfunction, generating a minimum amount of adequate tidal volume (TV) would be very difficult in propped up/supine/prone position, leading to worsening hypoxia and CO2 retention. We noticed a sustained increase in TV for patients with poor lung compliance (Cs <15 mL/cm H2O) and diaphragmatic dysfunction (bilateral diaphragmatic excursion <1 cm, on spontaneous breaths) when the patients are switched to Trendelenburg position with the same ventilator settings. Patients and methods: A case report with possible explanation for the observed changes has been mentioned. Results: Trendelenburg ventilation delivered more TV than propped up or prone ventilation in patients of ARDS with poor lung compliance and diaphragmatic dysfunction. Conclusion: Trendelenburg ventilation increases static lung compliance and delivers more TV when compared to propped up/supine/prone ventilation in patients of ARDS with poor lung compliance and diaphragmatic dysfunction. Although the exact mechanism behind this is not known till now, we formulated few theories that could explain the possible mechanism. [ABSTRACT FROM AUTHOR]

This study was conducted to investigate the influence of body position on respiratory compliance and oxygenation during iatrogenic pneumoperitoneum in the rabbit. The peak inspiratory pressure, dynamic compliance, static compliance and arterial gas parameters were calculated and measured 10 min before and 30 min after the creation of pneumoperitoneum with the patient in the horizontal position, 30 min after placing the patient in the Trendelenburg position and 30 min after placing the patient in the reversed Trendelenburg position. Following the creation of pneumoperitoneum and Trendelenburg positioning, there was a significant increase in peak inspiratory pressure while dynamic and static respiratory compliance decreased. Similarly, arterial oxygenation increased during Trendelenburg position while arterial carbon pressure remained within limits during all positions. Overall, the reverse Trendelenburg position did not improve ventilation, neither the oxygenation. However, this position showed to be more appropriate because may reduce the risk of lung injury associated with high-pressure ventilation during pneumoperitoneum. [ABSTRACT FROM AUTHOR]

Non-traumatic bilateral acute subdural hematomas are a rare occurrence. Etiologies typically include, but are not limited to, cortical artery bleeding, vascular lesions, coagulopathies, and spontaneous intracranial hypotension. We report a case of a 45-year-old Korean male with no known co-morbid illnesses nor history of head or neck trauma, who came to the emergency department due to a 10-day history of dizziness and head heaviness, followed by disorientation and drowsiness. The patient was diagnosed with bilateral acute subdural hematoma; hence, a bilateral posterior parietal craniotomy with evacuation of hematoma was performed. Neurologic status initially improved remarkably; however, during rehabilitation, there was recurrence of acute bilateral subdural hematoma requiring repeat surgical evacuation. There was no clinical improvement after the repeat surgery, and his condition further deteriorated in the neurosciences critical care unit showing signs of rostrocaudal deterioration at the level of diencephalon. A plain cranial CT scan was performed, which showed central herniation and "brain sagging." A diagnosis of spontaneous intracranial hypotension was considered; thus, the patient was managed by positioning him in the Trendelenburg position alternating with flat position on the bed. A search for the cerebrospinal fluid leak was commenced by performing a whole spine MRI constructive interference in steady state (CISS) protocol, which showed a longitudinal spinal anterior epidural cerebrospinal fluid leak from spinal level C2 to T1. Radionuclide cisternography did not provide definitive scintigraphic evidence of a leak. The patient gradually improved and was eventually transferred out of the neurosciences critical care unit. After days of rehabilitation in the hospital, the patient was discharged ambulatory with minimal support., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Pineda et al.)

Both the steep head-down position and pneumoperitoneum increase the intracranial pressure (ICP), and their combination for a prolonged period during laparoscopic radical prostatectomy (LRP) might influence the central nervous system homeostasis. Changes in optic nerve sheath diameter (ONSD) may reflect those in ICP. This study aims to quantify the change in ONSD in response to peritoneal CO2 insufflation and steep Trendelenburg position during LRP. ONSD was measured by ultrasound in 20 patients undergoing LRP and ten awake healthy volunteers. In patients, ONSD was assessed at baseline immediately after induction of general anesthesia in supine position, 10 and 60 min from baseline in a 25° head-down position during pneumoperitoneum, and after deflation of pneumoperitoneum with the patient supine at 0° angle. ONSD in controls was assessed at baseline with the patient lying supine, after 10 and 60 min of 25° head-down position, and 10 min after repositioning at 0° angle. ONSD increased significantly in both patients and controls (p < 0.0001) without between-group differences. The mean increase was 10.3% (95% CI 7.7-12.9%) in patients versus 7.5% (95% CI 2.5-12.6%) in controls (p = 0.28), and didn't affect the time to recovery from anesthesia. In the studied patients, with a limited increase of end-tidal CO2 and airway pressure, and low volume fluid infusion, the maximal ONSD was always below the cut-off value suspect for increased ICP. ONSD reflects the changes in hydrostatic pressure in response to steep Trendelenburg position, and its increase might be minimized by careful handling of general anesthesia. [ABSTRACT FROM AUTHOR]

Abstract Background We previously evaluated the efficacy of a ventilatory strategy to achieve expiratory flow bias and positive end-expiratory pressure (EFB + PEEP) or the Trendelenburg position (TP) for the prevention of ventilator-associated pneumonia (VAP). These preventive measures were aimed at improving mucus clearance and reducing pulmonary aspiration of bacteria-laden oropharyngeal secretions. This secondary analysis is aimed at evaluating the effects of aforementioned interventions on systemic inflammation and to substantiate the value of clinical parameters and cytokines in the diagnosis of VAP. Methods Twenty female pigs were randomized to be positioned in the semirecumbent/prone position, and ventilated with duty cycle 0.33 and without PEEP (control); positioned as in the control group, PEEP 5 cmH2O, and duty cycle to achieve expiratory flow bias (EFB+PEEP); ventilated as in the control group, but in the Trendelenburg position (Trendelenburg). Following randomization, P. aeruginosa was instilled into the oropharynx. Systemic cytokines and tracheal secretions P. aeruginosa concentration were quantified every 24h. Lung biopsies were collected for microbiological confirmation of VAP. Results In the control, EFB + PEEP, and Trendelenburg groups, lung tissue Pseudomonas aeruginosa concentration was 2.4 ± 1.5, 1.9 ± 2.1, and 0.3 ± 0.6 log cfu/mL, respectively (p = 0.020). Whereas, it was 2.4 ± 1.9 and 0.6 ± 0.9 log cfu/mL in animals with or without VAP (p

Robot-assisted surgeries are associated with steep positions which provide free operative field to surgeons; however, it becomes more challenging to the anaesthesiologists. In robot-assisted surgery, the patient is not usually accessible after docking in of robot, so monitors, circuits and tubes should be tightly secured and confirmed before handing over the patient to the surgeons. We report a patient with partial left axillary artery occlusion in a patient posted for robot-assisted radical cystectomy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of four recumbent body positions on intraocular pressure (IOP) in anesthetized normal horses. Animals studied: Ten nonglaucomatous adult horses. Procedures: Intraocular pressure was measured with a rebound tonometer in both eyes of standing sedated horses (baseline), then under general anesthesia during four randomized recumbent body positions, including Trendelenburg (Tr; 15‐degree head down), reverse Trendelenburg (RTr; 15‐degree head up), dorsal, and lateral; only the superior eye was measured in lateral positions. The mean of 3 IOP readings was taken at each position, allowing a minimum of 2 minutes of acclimatization after each position change before obtaining measurements. Repeated Measures Analysis with Newman‐Keuls Multiple Comparison Post hoc was used to compare IOPs in different positions, and linear regression was used to compare IOP with age and weight cofactors. Results: When compared to baseline, the greatest change in IOP occurred in Tr (increase of 25.63 ± 8.12 mm Hg). When comparing all recumbent positions to baseline, IOP significantly increased in 3 of 4 body positions (P <.001), with no significant difference identified between RTr and baseline. When comparing all body positions to each other, the greatest IOP difference occurred between the Tr and the RTr positions (increase of 26.95 ± 5.41 mm Hg). Age and weight were not correlated with IOP in any position. Conclusions: Recumbent body position significantly increases IOP in normal eyes of horses under injectable anesthesia. [ABSTRACT FROM AUTHOR]

Background and Aims: There is a wide variation in the anatomical relationship of the Internal Jugular Vein (IJV) to the Common Carotid Artery (CCA). This makes landmark based techniques of IJV cannulation and head rotation questionable and may lead to accidental arterial puncture. We conducted this study to determine the anatomical relation of the IJV to the CCA using (USG) in patients undergoing IJV cannulation for central venous access, and to analyse the effect of head rotation on this relationship. Material and Methods: A prospective observational study was conducted on 100 patients requiring central venous access, in the operation theatre or the intensive care unit. Anatomical relationship of the IJV to CCA at the level of the cricoid cartilage was analysed by noting the segment position (1-12) around the CCA using a high frequency linear USG probe on patients in neutral head position, on both sides and also with the head rotated to the contra lateral side by 15° and 45°. Results: Antero-lateral segments 1 and 2 were the most common positions (50% on the right and 73% on the left side). Change in segment causing increase in overlap of IJV and CCA with 15° head rotation was seen in 44% subjects on the right and 39% on the left. Statistically, a higher number of subjects showed overlap with 45° rotation (99% on right and 97% on left, P < 0.05). Conclusion: There is a wide variation in anatomical location of the IJV in relation to the CCA as seen by USG. Excessive head rotation causes overlap of IJV over CCA which may cause inadvertent arterial puncture, even under USG guidance. Thus, it is preferable to cannulate the IJV in neutral or near neutral head and neck position. [ABSTRACT FROM AUTHOR]

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Context: It has been theorized that a positive Trendelenburg test (TT) indicates weakness of the stance hip-abductor (HABD) musculature, results in contralateral pelvic drop, and represents impaired load transfer, which may contribute to low back pain. Few studies have tested whether weakness of the HABDs is directly related to the magnitude of pelvic drop (MPD). Objective: To examine the relationship between HABD strength and MPD during the static TT and during walking for patients with nonspecific low back pain (NSLBP) and healthy controls (CON). A secondary purpose was to examine this relationship in NSLBP after a 3-wk HABD-strengthening program. Design: Quasi-experimental. Setting: Clinical research laboratory. Participants: 20 (10 NSLBP and 10 CON). Intervention: HABD strengthening. Main Outcome Measures: Normalized HABD strength, MPD during TT, and maximal pelvic frontal-plane excursion during walking. Results: At baseline, the NSLBP subjects were significantly weaker (31%; P = .03) than CON. No differences in maximal pelvic frontal-plane excursion (P = .72), right MPD (P = 1.00), or left MPD (P = .40) were measured between groups. During the static TT, nonsignificant correlations were found between left HABD strength and right MPD for NSLBP (r = -.32, P = .36) and CON (r = -.24, P = .48) and between right HABD strength and left MPD for NSLBP (r = -.24, P = .50) and CON (r = -.41, P = .22). Nonsignificant correlations were found between HABD strength and maximal pelvic frontal-plane excursion for NSLBP (r = -.04. P = .90) and CON (r = -. 14, P = .68). After strengthening, NSLBP demonstrated significant increases in HABD strength (12%; P - .02), 48% reduction in pain, and no differences in MPD during static TT and maximal pelvic frontal-plane excursion compared with baseline. Conclusions: HABD strength was poorly correlated to MPD during the static TT and during walking in CON and NSLBP. The results suggest that HABD strength may not be the only contributing factor in controlling pelvic stability, and the static TT has limited use as a measure of HABD function. [ABSTRACT FROM AUTHOR]