Back pain in young athletes. Significant differences from adults in causes and patterns

The ubiquitous occurrence of Legionellae requires an exact typing of isolated strains in order to demonstrate the source of infection. Monoclonal antibodies, analysis of genomic and plasmid DNAs, and the typing of alloenzymes are suitable for this purpose. Typing of Legionella pneumophila serogroup 1 strains by using monoclonal antibodies was found to be a rapid and adequate method. Other serogroups of L. pneumophila and non-pneumophila species are of considerably less antigenic diversity, so that the use of monoclonal antibodies is not particular profitable. In such cases, genotypic methods are needed to discriminate between unrelated strains. There are no changes in the genome structure, defined as restriction patterns, during passages on artificial media and cultured Acanthamoeba. The possibility that different species, serogroups and monoclonal or genomic subtypes can be isolated in a given water supply points to necessity to test a sufficiently large number of colonies grown from the water samples. A clonal distribution of some Legionella strains has been observed.     

Pain in young adults: I. Relationship to gender and family pain history

OBJECTIVES/DESIGN: Two studies were carried out to examine how gender and family pain history related to pain and activity interference in young adults. The first study (n = 252 college students) examined how gender and family pain history related to pain intensity and the second study (n = 206 college students) examined how these variables related to pain intensity, location, and activity interference. Whenever possible, data from the two studies were combined for purposes of data analyses. RESULTS: Results indicated that more than half of the young adults studied reported experiencing some type of pain at the time of the investigation. The intensity of the pain was in the low range and the most frequent sites of pain were in the head and legs or feet. Gender differences were noted, with women reporting a greater number of sites of pain. Family pain history was found to be related to pain and activity interference. Subjects who had a strong family history of pain problems reported a greater number of pain sites, and higher levels of pain-related activity interference. CONCLUSIONS: Generalizability of results is limited due to the group of young adults studied, yet several conclusions relative to this group may be suggested. First, this group of young adults do appear to experience pain. Second, there may be gender differences in the types of pain they report and the ways they react to pain. Third, family history of pain may be related to the pain experiences of this group of young adults.     

The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain and related disability in Saskatchewan adults

STUDY DESIGN: Population-based, cross-sectional mailed survey. OBJECTIVE: To determine the lifetime, period, and point prevalence of neck pain and its related disability among Saskatchewan adults and investigate the presence and strength of nonresponse bias. SUMMARY OF BACKGROUND DATA: In Europe, the lifetime and point prevalence of neck pain is almost as high as the prevalence of low back pain. Similarly, chronic neck pain is highly prevalent and a common source of disability in the working-age population. However, no studies specifically have documented the prevalence of neck pain and its related disability in North America. METHODS: The Saskatchewan Health and Back Pain Survey was mailed to 2184 randomly selected Saskatchewan adults aged 20-69 years. Fifty-five percent of the study population participated. The presence of nonresponse bias was investigated through logistic regression and wave analysis. The Chronic Pain Questionnaire was used to classify the severity of chronic neck pain. RESULTS: The age-standardized lifetime prevalence of neck pain is 66.7% (95% confidence interval, 63.8-69.5), and the point prevalence is 22.2% (95% confidence interval, 19.7-24.7). The age-standardized 6-month prevalence of low-intensity and low-disability neck pain is 39.7% (95% confidence interval, 36.7-42.7), whereas it is 10.1% (95% confidence interval, 8.2-11.9) for high-intensity and low-disability neck pain and 4.6% (95% confidence interval, 3.3-5.8) for significantly disabling neck pain. The prevalence of low-intensity and low-disability neck pain decreases with age. More women experience high-disability neck pain than men. Wave analysis suggests that the point prevalence and 6-month prevalence of high-intensity and low-disability neck pain are overestimated in this survey. CONCLUSION: This cross-sectional study shows that neck pain is highly prevalent in Saskatchewan and that it significantly disables 4.6% (95% confidence interval, 3.3-5.8) of the adult population.     

Back pain following epidural anaesthesia in labour

For palliative therapy of Duchenne muscular dystrophy (DMD), corticosteroids have been tried since 1970. According to recent reports, corticosteroids maintained muscular strength to some extent and prolonged period of ambulation. However, their mechanism of action is mostly unclear. In the present study, mdx mice were injected with 0.6 mg prednisolone 3 times a week for 30 weeks. Serum creatine kinase (CK) values remained 23% of controls. In muscle pathology of the quadriceps muscle, fibers with peripheral nuclei were increased, suggesting reduction of muscle necrosis. In pathological examination of liver, pyknotic cytoplasmic masses and formation of vacuoles were observed. Present study showed that prednisolone might attenuate muscle fiber necrosis at least for 30 weeks. Prednisolone may reduce secondary tissue reactions, which develop more serious muscle damage.     

Vaginal replacement in children and young adults

PURPOSE: Absence of the vagina in the pediatric population most commonly results from congenital abnormalities, such as the Mayer-Rokitansky syndrome but it may also be seen after treatment for pelvic tumors, such as rhabdomyosarcoma, and in patients who have had previous gender reassignment. We review our experience using bowel for vaginal replacement in a group of children and young adults to assess outcome and satisfaction. MATERIALS AND METHODS: From 1980 to 1996 we evaluated 31 patients 1 to 20 years old who required vaginal replacement. Presenting diagnoses included müllerian failure (the Mayer-Rokitansky syndrome) in 20 patients, androgen insensitivity syndrome in 5, rhabdomyosarcoma in 3, penile agenesis in 1, cloacal exstrophy in 1 and 1 previously separated conjoint twin. A questionnaire was given to 26 of the 31 patients to assess postoperative sexual function and satisfaction. RESULTS: A total of 33 bowel segments in 31 patients were used for vaginal reconstruction, including sigmoid colon in 20, ileum in 8 and cecum in 5. Of the 31 patients 20 were sexually active, 8 were married and 3 had been previously married and divorced. Only 1 patient described chronic dyspareunia. Three patients were on chronic home dilation, while 4 required sanitary pads for vaginal secretions. There were 8 complications in the 31 patients, including stenosis of the bowel segment in 6. Three patients required a second procedure after total stenosis of the small bowel vagina (2) and prolapse of the neovagina (1), which required retroperitoneal fixation. CONCLUSIONS: Experience with this group of patients leads us to believe that isolated bowel segments provide excellent tissue for vaginal replacement. Furthermore, we believe that colon segments, particularly sigmoid, are preferable to small bowel for creation of the neovagina. In many instances the small bowel mesentery may be too short to provide an adequate, tension-free anastomosis in the perineum, particularly in obese patients. Our results would also suggest that sexual activity is more compatible with isolated bowel segments for vaginal replacement than with any of the more traditional methods, such as passive dilations and split thickness skin graft vaginoplasty.     

Impact of sonography on the diagnosis and treatment of acute lower abdominal pain in children and young adults

OBJECTIVE: Our purpose was to evaluate the impact of sonographic data on clinical physicians' diagnostic confidence and their treatment of children and young adults with acute lower abdominal pain. SUBJECTS AND METHODS: Senior surgical and emergency department staff completed questionnaires before and after abdominal sonography was performed on 94 of 101 consecutive children and young adults with acute lower abdominal pain, pelvic pain, or both. Physicians who were unaware of sonographic data stated the most likely diagnosis and their level of confidence in their diagnosis and then formulated clinical plans. After they were given sonographic data, physicians again stated the most likely diagnosis, estimated their level of confidence, and formulated revised treatment plans. RESULTS: Sonographic data resulted in revised clinical diagnoses in 52% of the patients. Overall, the gain in diagnostic confidence for the entire study population was 33% (95% confidence interval [CI], 27-38%; p < .0001). The impact on the physicians' confidence was greater in those children and young adults whose diagnoses changed after sonography (mean increase in physicians' confidence, 48.3%; 95% CI, 47-75%). In patients whose diagnoses were not changed after sonography, the mean increase in physicians' confidence was 17.6% (95% CI, 11-24%; p < .0001 [analysis of variance]). Physicians used sonographic data to change initial treatment plans in 43 patients (46%). Of these 43 patients, a lower intensity of care was given to 30 patients (70%) and a higher intensity to 13 patients (30%). CONCLUSION: Sonographic data frequently changed initial clinical diagnoses, thus increasing diagnostic confidence and changing clinical treatment decisions in the setting of acute lower abdominal pain in children and young adults.     

Multiple-risk behaviour in adolescents and young adults

OBJECTIVES: This article examines the prevalence of four risk behaviours among teenagers and young adults: smoking, binge drinking, sex with multiple partners, and sex without a condom. DATA SOURCE: The data are from a Health Canada-sponsored supplement to the 1994/95 National Population Health Survey. The analysis is based on 905 respondents aged 15 to 19 and 1,055 respondents aged 20 to 24. ANALYTICAL TECHNIQUES: Prevalence estimates of the four risk behaviours were calculated for males and females in each age group. An index of multiple-risk behaviour was derived by summing the four risk behaviours. Hierarchical multiple regression was used to examine how sets of variables are related to multiple-risk behaviour. MAIN RESULTS: Multiple-risk behaviour was higher among young people who had never married, who were not students, and who did not live with a parent. Feeling distressed was positively linked with multiple-risk behaviour, while regular attendance at religious services was negatively linked with such conduct.     

Conditioned-reflex facilitation in young and older adults

Young (18-30 years) and elderly (63-88 years) human subjects received 70 trials of single-cue classical eyeblink conditioning (paired group), or 70 explicitly unpaired presentations of the tone conditioned stimulus (CS) and airpuff unconditioned stimulus (unpaired group). Before and after conditioning, reflex-eliciting white noise and corneal airpuff stimuli were presented alone or paired with the CS to investigate the effects of conditioning on eyeblink reflex amplitude. The results showed increased conditioned responses in the paired group compared to the unpaired group for the young but not the elderly subjects. There was, however, evidence of conditioned facilitation of noise-elicited reflexes in both young and elderly subjects. These data indicate that conditioned facilitation of the startle reflex may be a sensitive indicator of classical conditioning processes in human subjects.