[Measurement of torque in bone screws during surgery].
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Many neuromuscular diseases are associated with muscle weakness. Assessment of this weakness by manual muscle testing or with hand-held equipment has been criticized. Furthermore, muscle length influences peak force development. One hundred fifty-three female and 116 male asymptomatic subjects between the ages of 20 and 80 (approximately 20 per decade) were studied. Maximal strength of the quadriceps group was determined isometrically, on a specially designed bench, at 3 hip angles (45 degrees, 90 degrees, and 180 degrees of extension), which represent three rectus femoris muscle lengths. Maximal strength was observed at a hip angle of 180 degrees and did not decrease significantly from 20 to 50 years of age, although the values for the male and female subjects over 50 years were significantly decreased (approximately 15% per decade). The increase in strength as the muscle was lengthened from 45 degrees to 180 degrees hip angle was about 80% (of the force at 45 degrees) in 20-year-olds; strength decreased progressively with age to a value of approximately 50% in the 70-year-olds. This greater reduction in maximal strength at longer quadriceps muscle lengths has functional significance in rising from a chair, climbing stairs, and eventually, walking and standing.
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The author proposes to direct the attention of obstetricians to certain features of the physiological birth process to which little consideration has been given. These features have been unjustly neglected, because after their careful and in-depth analysis, the somewhat disconcerting suspicion is raised that the term "birth canal", as traditionally perceived and explained in obstetrical treatises, is totally inappropriate. The author would in fact like to provoke discussion regarding the suitableness of substituting the usual didactic expression "birth canal" with the new term "pelvic press", which is more to the point in evidencing an important physiological action, similar to that of a hydraulic press, which, in his opinion, starts between the bony walls of the pelvis during the second stage of labor. The author maintains that the functional role of the "pelvic press" consist in the multiplication of part of the expulsive forces set off by the uterus and the abdominal musculature to determine rotation movements of the presenting part, and, above all, to serve as a most valid protective action for the fetus throughout the entire birth process.
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