Knowledge of asthma among parents of asthmatic children

The knowledge and attitude towards asthma, of parents, of 85 asthmatic children was assessed using a 17 item questionnaire. Results showed that 34.1% believed asthma to be contagious, 48.2% of the parents hesitated in referring to their child's illness as asthma. Other commonly held beliefs were that asthma is a life long illness (35.3%); food items are important precipitating factors for acute attacks (88.2%); mild exacerbations need to be treated with bronchodilators (6.3%); bronchodilators should be started at home before consulting a physician in case of an acute attack (61.2%); and cure of asthma is possible through modern drugs (30.6%) or through alternative systems of medicine (65%). Ninety one per cent of parents lacked an awareness of the side effects of anti-asthma medication. It is concluded that parental education through improved physician parent communication is necessary for enhancing the quality of care being provided to children with asthma, a fact also highlighted by the International Consensus Report on Management of Asthma.     

The psychotherapist and the adolescent athlete

Previous studies on the mRNA and protein level suggested a cardioprotective role of FGF-1. These presumed actions of FGF-1 and FGF-2, as well as the underlying mechanisms, were investigated in this study. Human recombinant FGF-1 (0.5 microgram/ml, 20 microliters/min) and FGF-2 (2 micrograms/ml) were applied by means of direct intramyocardial infusion (IM) for 60 min prior to a 60 min LAD-occlusion and 120 min reperfusion. Myocardial infarction compared to the region at risk was significantly decreased by FGF-1 and FGF-2 treatment (FGF-1: 51.8 +/- 7.7%, respectively. FGF-2: 57.3 +/- 6.5% v control 83.4 +/- 2.8%, P < 0.05). The increase in survival time was about 33 min, and equalled that of ischemic preconditioning. This effect was caused by the mitogenic part of the molecule, since infusion of a truncated version of FGF-1 (0.5-1 microgram/ml), lacking mitogenicity but maintaining hemodynamic activity, did not induce cardioprotection (78.3 +/- 0.73% v control 83.4 +/- 2.8%). Suramin (0.5 microgram/ml) prevented the observed cardioprotection (77.0 +/- 1.2% v control 83.4 +/- 2.8%) proving that the cardioprotective effect is receptor-mediated. Genistein (0.5 microgram/ml), an inhibitor of tyrosine kinases, abolished the cardioprotection as well (77.2 +/- 2.4% v control: 83.4 +/- 2.8%). Immunohistochemical staining revealed an uptake and translocation of exogenous FGF-1 to a (peri-)nuclear localization in myocytes and into non-myocytes for FGF-2. We conclude that both FGF-1 and FGF-2 are cardioprotective (FGF-1 being more active on a molar basis), and mimic ischemic preconditioning. Their actions are receptor-mediated and receptor activation is involved. Uptake and transport to a (peri-)nuclear localization, seems to be a pathway of minor relevance, since it could not be blocked by tyrosine kinase receptor inhibition. Tyrosine kinase-coupled receptor occupation in general is not protective as demonstrated by the lack of effect with VEGF-infusion.     

Uncomplicated asthma in adults: comparison of CT appearance of the lungs in asthmatic and healthy subjects

A study was undertaken to define the computed tomographic (CT) appearance of the lungs in subjects with uncomplicated asthma and to compare the prevalence of bronchial dilatation at CT in asthmatic and healthy subjects. Clinical features, pulmonary physiologic findings, chest radiographs, and high-resolution CT scans of 48 asthmatic subjects were reviewed. Forty-one (85%) of the 48 asthmatic subjects were undergoing bronchodilator therapy, 28 (58%) were undergoing steroid therapy, and 21 (44%) were cigarette smokers. Twenty-seven healthy control subjects underwent limited high-resolution CT. At selected CT levels, any bronchus with an internal diameter greater than that of the accompanying pulmonary artery was considered dilated. In the asthmatic subjects, 153 (36%) of 429 bronchi evaluated met criteria for bronchial dilatation compared with 37 (26%) of 142 bronchi in the control group (P < .05). Because bronchial dilatation demonstrated at CT did not correlate with clinical data, the authors conclude a bronchus larger in diameter than the adjacent vessel is not sufficient evidence to diagnose cylindric bronchiectasis.     

Sub-clinical worsening of bronchial asthma during estrogen replacement therapy in asthmatic post-menopausal women

BACKGROUND: Changes in asthma activity, in part related to the female hormonal profile, have been observed during pre-menstrual periods and during pregnancy. Estrogen replacement therapy (ERT) is an accepted routine treatment for post-menopausal women. The effect of ERT on disease activity in post-menopausal asthmatic women has not been investigated in the past and is the subject of the present study. METHODS: Fifteen post-menopausal women with mild to moderate asthma completed two 30-day periods in which they measured peak expiratory flow (PEF) at home and filled in a daily diary of asthma-related symptoms. The first monitoring period was pre-ERT and the second was during ERT. In addition spirometry was performed on each woman three times, twice pre-ERT and once during ERT. RESULTS: The average daily PEF decreased from 241 (57.9, S.D.) l/min pre-ERT to 226.7 (62.7) l/min during ERT (P < 0.004). Significant differences between the two study periods were also found in morning and evening PEF values. Diurnal variation, measured as the difference between morning and evening PEF values, decreased significantly from 22.3 (26.7) l/min pre-ERT to 17.5 (26.8) l/min during ERT (P < 0.007). The average daily consumption of bronchodilator inhalers increased significantly from 3.7 puffs/day pre-ERT to 4.3 puffs/day during ERT (P < 0.006). Although the differences in spirometry between the two periods did not reach statistical significance, a trend towards a worsening of the obstructive disorder during ERT was observed. However, the general feeling of well-being of the asthmatics did not change during the two periods. CONCLUSIONS: During ERT a sub-clinical worsening of disease activity was found in postmenopausal women with mild to moderate asthma. We also detected a decrease in diurnal variation. Our findings should be substantiated by additional studies.     

Hallux limitus in the athlete

Hallux limitus is one of the more common conditions occurring around the great toe, characterized by a progressive decrease in the dorsiflexion range of motion at the first metatarsophalangeal joint. Bony proliferation and articular degeneration of the joint result in pain and possible disability. Any force or condition which results in the restriction of dorsiflexion at the 1st metatarsophalangeal joint may, over time, produce typical changes around the metatarsophalangeal joint including the formation of dorsal exostosis, marginal osteophytes, erosion of articular cartilage and possible ankylosis. All of these changes are capable of producing pain in and around the joint. In summary, the condition is characterized by bony adaptations around the joint (hypertrophic spurring/ osteophytes, etc.) and eventual degeneration and destruction of the articular cartilage of the joint, possibly resulting in ankylosis. This article will review the biomechanical influences which may lead to hallux limitus/hallux rigidus, the clinical evaluation of the condition and suggestions for subsequent treatment.     

Exercise-induced airway obstruction

Exercise is one of the most common precipitants of acute asthma encountered in clinical practice. This article examines the prevalence of this condition. Topics discussed include historical review, current concepts of pathogenesis, clinical features, late reactions, diagnosis, and therapy.     

The female athlete

Although there are many similarities between men and women involved in sport activities, certain issues are unique to the female athlete. This article presents and brings to light some of the more important concerns that are specific to women engaged in sports.     

The female athlete

Women's participation in sporting activities is now diverse with new opportunities arising yearly. As a result, care of the the female athlete's unique medical concerns has become an important challenge and issue to the primary care physician. The major focus when caring for the female athlete should be the diagnosis and treatment of the female athlete triad. The components of the triad--disordered eating, amenorrhea, and osteoporosis--can have serious implications for the health of the female athlete. Appropriate prevention and screening methods for early diagnosis of the female athlete triad require future study and improvement. Healthy pregnant, postpartum, and breastfeeding women can continue to maintain physical activity. Musculoskeletal injuries from sports are, in general, not gender specific but are more often sport specific. One exception is the increased prevalence of anterior cruciate ligament injuries occurring in women soccer and basketball players. The exact cause of this is unknown but is continuing to be investigated.     

Upper-extremity tendinitis and overuse syndromes in the athlete

Overuse injuries are the result of repetitive microtrauma to the musculotendinous unit. Treatment protocols are based on the stage of the inflammatory process that is active at the time of diagnosis. Control of the inflammatory response with rest, elevation, and ice is the treatment objective during the inflammatory stage. Prevention of further injury is the primary treatment goal throughout the proliferative phase. Once the inflammatory process has reached the maturation stage, rehabilitation can begin with flexibility exercises, isometric contractions, and a slow return to strength training. Surgical decompression is frequently necessary if chronic inflammation causes fibrosis of the fibro-osseous tendon sheaths. Anomalous muscle bellies and tendinous interconnections can be contributing factors to overuse syndromes. Properly structured training programs and rehabilitation regimens can prevent tendinitis and overuse syndromes.     

Infracalcaneal heel pain in the athlete

Heel-spur syndrome is a condition encountered on a daily basis by those practitioners who primarily treat athletes. The authors discuss anatomy, the clinical examination, radiographic evaluation, exercise, and alternative medicines.     

Cardiovascular evaluation of the young athlete

Young athletes with possible cardiac problems may require medical advice, sports medicine information, and treatment before a clinician can sanction sports participation. In addition, the potential medical liability of cardiac abnormalities makes the preparticipation cardiac evaluation a top priority. The author emphasizes the importance of obtaining a thorough cardiac history and performing a cardiac-specific physical examination, which may include diagnostic tests such as the treadmill and color flow Doppler echocardiography. Common cardiac referral complaints such as chest pain, murmurs, and syncope are also reviewed.     

The female athlete triad

The opportunities for girls and women to play soccer has rapidly grown and gained acceptance in recent years. The benefits of involvement in soccer, both physically and psychologically, are overwhelmingly positive. Despite the benefits, girls and women involved in soccer are also at risk for medical problems as a result of their sports participation. Amenorrhea, disordered eating, and premature osteoporosis are entities known together as The Female Athlete Triad. The triad occurs in all sports and is associated with significant short- and long-term health consequences, and thus remains a concern for all involved in the care of the soccer athlete.     

Elbow, forearm and wrist injuries in the athlete

Competitive and recreational athletes sustain a wide variety of soft tissue, bone, ligament, tendon and nerve damage to their upper extremities. Most such injuries are related to direct trauma or repetitive stress, and account for a significant amount of 'down time' for athletes participating in a wide range of sports, particularly those in which the arm is utilised for throwing, catching or swinging. Overuse injuries to the elbow include musculotendinous injuries, ulnar nerve injuries and ligamentous injuries. Osteochondrol lesions of the capitellum and posterior impingement injuries in the joint are frequently seen in athletes as well. Acute traumatic injuries to the elbow include tendon ruptures, elbow dislocations and intra-articular fractures. Forearm overuse injuries in athletes include fracture of the carpal scaphold, fracture of the hook of the hamate, Kienbock's syndrome and pisoquetral syndromes. ligamentous injuries include scapholunate, lunotriquetral and midcarpal instability injuries. Injuries to the distal radio-ulnar joint and triangular fibrocartilage are also quite common in athletes, and require careful evaluation and treatment.     

The medical demands of the special athlete

BACKGROUND AND AIMS: Before choosing between open and laparoscopic preperitoneal tension-free repair, a study comparing their safety and short-term outcome was needed. No randomised studies comparing the two hernia repair techniques have hitherto been published. MATERIAL AND METHODS: A prospective randomised study was carried out comparing laparoscopic transabdominal preperitoneal mesh herniorrhaphy (n = 24) to open preperitoneal mesh herniorrhaphy (n = 25). RESULTS: When comparing unilateral repairs, the mean operation time was significantly (P < 0.01) shorter in the open group (55 min) than in the laparoscopic group (66 min). Pain on movement (P < 0.05) and pain on coughing (P < 0.01) receded more rapidly in the laparoscopic group. The median time before return to work or normal activity was 7 days (range 1-60) in laparoscopic and 5 days (1-30) in open repair. There were five (21%) complications associated with the laparoscopic procedure, while the open procedure resulted in two (8%) complications. After a median follow-up of 18 months the recurrence rate in the laparoscopic group was 13% and in the open group 8%. CONCLUSIONS: In this study the open method was associated with fewer complications and recurrences than the laparoscopic technique. Despite the decreased postoperative discomfort after laparoscopic repair, there was no significant difference in median time before return to work or normal activity. These results together with the higher cost of the laparoscopic procedure suggest that the open method is more suitable at least for unilateral hernias.     

Multidirectional instability of the shoulder in the athlete

Laxity of the inferior glenohumeral ligament is the essential lesion in involuntary multidirectional instability of the shoulder. Most important in the diagnosis, which is difficult to make, is the physical examination. Treatment consists of strengthening the muscles in the direction of the greatest instability. If this fails after a year, surgery is indicated.     

Considerations for the treatment of the injured athlete

We found a variable defect of complex I of the mitochondrial respiratory chain, ranging in severity from 25% to 63% of control values, in muscle of patients with Huntington's disease (HD). The most severe defect was observed in the patient with the greatest expansion of CAG triplets. Muscle morphology showed myopathic changes such as moth-eaten fibers, angulated fibers, increased subsarcolemmal oxidative activities, or an increased number of enlarged mitochondria with abnormal cristae. Multiple mitochondrial DNA deletions were found by polymerase chain reaction (PCR) analysis in muscle of the patient with the most severe defect of complex I. Our data further support the involvement of energetic defects and oxidative damage in muscle of patients with HD.