The rupture and intravascular migration of the distal fragment of a central venous access catheter

Patients free from occlusal dysfunction rarely have their teeth together. But, when occlusion does occur (i.e., swallowing), the contacts should be simultaneous and in such a manner as to direct the vector of force down the long axis of the tooth or implant. The incline planes should not touch.     

Complete sequence of the bithorax complex of Drosophila

The bithorax complex (BX-C) of Drosophila, one of two complexes that act as master regulators of the body plan of the fly, is included within a sequence of 338,234 bp (SEQ89E). This paper presents the strategy used in sequencing SEQ89E and an analysis of its open reading frames. The BX-C sequence (BXCALL) contains 314,895 bp obtained by deletion of putative genes that are located at each end of SEQ89E and appear to be functionally unrelated to the BX-C. Only 1.4% of BXCALL codes for the three homeodomain-containing proteins of the complex. Principal findings include a putative ABD-A protein (ABD-AII) larger than a previously known ABD-A protein and a putative glucose transporter-like gene (1521 bp) located at or near the bithoraxoid (bxd), infra-abdominal-2 (iab-2) boundary on the opposite strand relative to that of the homeobox-containing genes.     

Tendinous insertion of semimembranosus muscle into the lateral meniscus

Forty-two cadaver knees were used for morphologic and MRI observations of the tendinous distal expansions of the semimembranosus m. and the posterior capsular structures of the knee. A tendinous branch of the semimembranosus m. inserting into the posterior horn of the lateral meniscus was found in 43.2% of the knees dissected, besides five already known insertional branches; capsular, direct, anterior and inferior, as well as the oblique popliteal ligament. The tendon had three morphologic types; thin, broad and round. All three types moved the lateral meniscus posteriorly when pulled on. Thus, the semimembranosus m. may also have a protective function for the lateral meniscus as well as the already well established function of protecting the medial meniscus in knee flexion. When a semimembranosus tendon attachment to the posterior horn of the lateral meniscus is present, its normal insertion is difficult to differentiate from a lateral meniscus tear in MRI and this may cause misdiagnosis.     

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.     

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.     

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.     

Repair of chronic distal biceps brachii tendon rupture using free autogenous semitendinosus tendon

Distal biceps brachii tendon ruptures occur much less frequently than do their proximal counterparts. Distal tendon ruptures usually are associated with considerable function deficits and may require surgical treatment. Repair of chronic distal biceps brachii ruptures are extremely unusual. A free autogenous semitendinosus tendon graft was used to reconstruct the distal biceps tendon by reattaching the graft to the radial tuberosity via a 2-incision technique in a patient with symptoms and a chronic injury.     

Atypical vagal Wenckebach period in a high performance athlete

A 27-year-old man, engaged in heavy physical training, exhibited sinusbradyarrhythmia with atrial abnormality and second degree av-block (atypical Wenckebach period). Since abnormal sinusrhythms was established with exercise and following parasympathetic blockade, this rhythm disorder was considered consequential exaggerated vagal tone. With the aid of His-bundle electrocardiography the block was localized in the av-node (AH).     

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.     

Glenoid fracture nonunion presenting as instability in a young athlete

A case of a teenage athlete with a 4-year history of shoulder pain caused by glenoid fracture nonunion is presented. This individual had findings consistent with traumatic anterior shoulder instability as well as normal radiographs. Arthroscopy showed a nondisplaced glenoid fracture that was stabilized successfully through a deltopectoral approach.     

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.     

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.     

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.     

Radial artery thrombosis in a young athlete. A case report

A continuous culture of Saccharomyces cerevisiae strain IFO 0233 growing aerobically at pH 3.4 shows persistent high-amplitude respiratory oscillations with a period of about 45 min. These robust autonomous cycles are accompanied by changes of product accumulation (acetaldehyde and acetic acid), intracellular pH, and intracellular redox state, as indicated by continuously monitored NADH fluorescence and the glutathione content of cell-free extracts. Perturbation of the oscillation of dissolved O2 was produced on addition of 100 microM glutathione, > 10 nM Na nitroprusside, 8 microM NaNO2, or 10 microM S-nitrosoglutathione. NO gas, putative NO.-releasing agents, or an inhibitor of NO synthase were ineffective. We suggest that nitrosation by NO+ of a component of a redox switch can account for these data, and we emphasise the different modes of action of the different redox forms of nitrogen monoxide.     

Creep rupture in a nickel-based superalloy

Smooth bar creep rupture tests were conducted under constant loads at 1033 and 1144 K using RENé 80. Creep deformation occurred dominantly by the dislocation creep mechanism, but creep rupture proceeded by the continual nucleation and growth of cavities. Rupture times were well predicted by the constrained diffusive growth model of Riedel, particularly at low applied stresses, but their temperature dependence and the Monkman-Grant product were better related to the unconstrained diffusive growth models. Interruption tests showed development of micro- cracks in the tertiary stage of creep and sometimes revealed edge cracks, the growth of which provided the creep crack growth rate.     

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.     

Stress fracture of the sixth rib in an elite athlete

We report on a previously unreported site of rib stress fracture in an elite athlete. A 27 year old sweep rower, a National champion and an Olympic finalist, presented with a 3-day history of the left-side thoracic pain. Technetium 99m bone scintigraphy showed increased focal uptake of the radioisotope, leading to the diagnosis of stress injury of the anterolateral part of the sixth rib. The probable mechanism of this injury was that strong muscle force itself was great enough to produce a fracture. In the case of our rower, the precipitation cause was only a slight change in the rowing technique, in contrast to all other reports on such rib fractures among rowers where the primary cause was an increase in the level of strength training. The treatment included a complete rest of the affected area and upper extremities, while the cardiovascular and strength fitness was maintained. The athlete was able to resume with his standard training routine less than four weeks after the onset of the symptoms.