Diagnosis,treatment, and rehabilitation of the thrower’s elbow

The overhead throwing motion generates enormous force in the elbow. Repetitive near failure loads lead to chronic adaptive changes and occasionally acute injury. The physician caring for the thrower must understand the complex anatomy and function of the elbow joint, along with the biomechanics of throwing, to accurately diagnose and treat elbow pathology. Evaluation of elbow pain in the throwing athlete must begin with a thorough and detailed throwing history including duration of symptoms, location of pain, timing during the phases of throwing motion, and associated symptoms. Physical examination should include inspection, range of motion, palpation, and specific tests to better define the pathology. A detailed history and physical examination will allow the astute clinician to obtain the proper diagnosis and start the appropriate operative or nonoperative treatment often without reliance on ancillary testing. Treatment and rehabilitation of these injuries must be tailored to the pathology present and focused towards a return to the athlete’s activity.     

Ultra-triathlon—Pacing,performance trends,the role of nationality,and sex differences in finishers and non-finishers

Ultra-triathlons are defined as triathlons longer than the traditional Ironman distance and became more popular in the last two decades; however, scarce scientific evidence of these events are available. Therefore, we aimed to investigate the trends of performance, pacing, nationality, sex differences, and rate of non-finishers in ultra-triathlons. Data from 1985 to 2018 were collected including Double Iron, Triple Iron, Quintuple Iron, and Deca Iron ultra-triathlons. Different pacing patterns by event and sex were observed (P < .05); athletes spent less %time in swimming and cycling, and more %time in running as the distance of event was longer; women spent more %time in cycling and less% time in running in Double and Triple. Performance analysis showed a negative trend over time for men and women since 1985. Switzerland, France, and Germany were the fastest nations in ultra-triathlons. The frequency of North Americans competing in Europe was very low (<5%), whereas Europeans often competed in North America (~25%). The rate of non-finishers between sexes was similar in all races with the exception of Deca Iron ultra-triathlon, which was much greater (~20%) for women. Non-finishers had slower race times in swimming and cycling splits than finishers. In conclusion, ultra-triathletes should redistribute their energy among swimming, cycling, and running depending on their sex and distance of race. Performance in ultra-triathlons has been decreasing in men and women over the years, but sex difference in performance remained. Europeans were the fastest ultra-triathletes and compete in Europe and North America. Additionally, non-finishers were slower swimmers and cyclists than finishers.     

Trabecular bone structure of the distal radius, the calcaneus, and the spine: which site predicts fracture status of the spine best?

RATIONALE AND OBJECTIVES: To compare trabecular bone structure measures obtained in magnetic resonance images of the distal radius and the calcaneus as well as computed tomographic images of the spine versus bone mineral density (BMD) of the spine and the calcaneus in the prediction of osteoporotic spine fracture status. MATERIAL AND METHODS: High-resolution magnetic resonance images of the calcaneus and the distal radius and thin-section computed tomographic images of thoracic and lumbar vertebrae were obtained from 74 cadavers. Structure analysis was performed using parameters analogous to standard histomorphometry. BMD of the spine was determined by using quantitative computed tomography and of the calcaneus by using dual x-ray absorptiometry. Spine radiographs of these cadavers were assessed concerning vertebral deformities. RESULTS: The diagnostic performance in differentiating fracture and nonfracture subjects was highest for structure parameters in the spine and slightly lower for these parameters in the distal radius and for BMD of the spine. CONCLUSION: In this study structure parameters in the spine were best suited to predict the osteoporotic fracture status of the spine.     

After Kosovo, Afghanistan and Iraq: what is the future for the UN?

There have been enormous changes in the world order over the last 15 years, which have seen the United States, closely supported by the United Kingdom, become more unilateral in its actions, and in doing so damaging the United Nations. Attempts to create an ethical dimension in foreign policy have failed. The brief consensus after 9/11 has been lost in the war against terror, whilst other more appropriate measures to diminish the risks of terrorism, such as creating greater equity in trade and meeting the UN millennium goals, have been left to one side. Iraq and the ongoing failure to resolve the Palestinian issues have left the world a less safe place. The need for the UN to establish itself as a dominant force for global justice is paramount. To do so there must be reform, particularly of the Security Council.     

Perfusion MRI in the evaluation of the relationship between tumour growth,necrosis and angiogenesis in glioblastomas and grade 1 meningiomas

Angiogenesis is a common characteristic of tumours, and it is reasonable to assume that it has an influence on tumour growth, depending on the grade of malignancy. We therefore studied angiogenesis in 25 patients: 14 with glioblastoma multiforme and 11 with grade I meningioma. Our aim was to assess how angiogenesis conditions growth and necrosis. The patients underwent MRI with standard and perfusion sequences. We calculated the volume of each tumour; for the glioblastomas the solid portion was taken as the difference between the overall volume and the volume of any necrotic portion. In the glioblastomas, we found an inverse relationship between blood volume and the size of the tumour, whereas in the meningiomas there was of a direct relationship. These correlations confirm in vivo the knowledge about necrosis in glioblastomas and its relationship to their inadequate vascular network. On the contrary, grade 1 meningiomas show an equilibrium between their microcirculation and the cellular component.     

Hungarian population data on the loci HLA-DQα, LDLR,GYPA, HBGG,D7S8 and GC

Population data studies for HLA-DQa and PM loci (LDLR, GYPA, HBGG, D7S8, GC) were carried out on a Hungarian Caucasian population sample of 163 unrelated individuals. Whereas the observed PM allele frequencies were similar to those reported for Caucasians, significant differences were found for HLA-DQa between the Hungarian and some Caucasian population data. All six loci meet Hardy-Weinberg expectations and there is no evidence for association between any pairs of loci.     

Does nitric oxide help explain the differential healing capacity of the anterior cruciate, posterior cruciate, and medial collateral ligaments?

This study compared the ability of rabbit medial collateral ligament, posterior cruciate ligament, and anterior cruciate ligament tissue to synthesize nitric oxide, and determined its effects on matrix synthesis, an important component of ligament repair. It is not known whether ligament cells can produce nitric oxide and, if so, whether it influences healing of ligament injuries. The anterior cruciate and posterior cruciate ligament tissue produced large amounts of nitric oxide in response to the inflammatory cytokine interleukin-1. Medial collateral ligament, in contrast, produced only modest amounts of nitric oxide. Furthermore, anterior cruciate ligament and, to some degree, posterior cruciate ligament synthesized nitric oxide spontaneously in culture, whereas medial collateral ligament never did so. When nitric oxide was supplied to these tissues, it strongly inhibited collagen synthesis by the two cruciate ligaments, but had little effect on collagen synthesis by the medial collateral ligament. Endogenously synthesized nitric oxide was also able to inhibit collagen synthesis as well as proteoglycan synthesis by the two cruciate ligaments, but had little effect on matrix synthesis by the medial collateral ligament. We propose a novel hypothesis, based on nitric oxide production and matrix synthesis, that may help explain why the two cruciate ligaments have such limited healing capacity compared with the medial collateral ligament.     

The effect of the most common gait perturbations on the compensatory limb’s ankle,knee, and hip moments during the first stepping response

BackgroundTrips and slips, the two most common gait perturbations, often cause falls. Multiple studies have focused mainly on the kinematics of multiple body segments in response to an unexpected trip or slip induced by mechanical obstacles, cables, treadmills, and slippery agents or contaminants on a floor. Few studies have examined the joint moments of the compensatory limb following an unexpected trip on an obstacle.Research questionThis proof-of-concept study sought to assess the ankle, knee, and hip moments of the compensatory limb during normal walking and the first stepping response following the two most common gait perturbations.MethodsEighteen healthy young adults completed 4 trials (2 trials with a random trip perturbation and 2 trials with a random slip perturbation) while walking on a split-belt treadmill. In each trial, the motorized treadmill induced either an unexpected trip or slip perturbation to the left foot between the 31 st and 40th step randomly. A motion capture system recorded the positions of body segments, the joint moments (i.e., ankle, knee, and hip moments) of the compensatory limb were quantified, and the maximum joint moments were assessed during normal walking and the first stepping response.ResultsCompensatory limb’s ankle plantarflexion, knee flexion, hip flexion, and hip extension moments were significantly higher for a slip perturbation than for a trip perturbation during the first stepping response. Compensatory limb’s knee flexion, hip flexion, and hip extension moments were also significantly higher during the first stepping response to a slip perturbation compared to normal walking.SignificanceThis proof-of-concept study is the first to investigate the ankle, knee, and hip moments of the compensatory limb during the first stepping response following unexpected gait perturbations induced by a split-belt treadmill. The findings are expected to improve the gait perturbation paradigms developed for training balance-impaired individuals.     

Scientific and educational abstracts presented at the ASER 2010 annual scientific meeting and postgraduate course August 11–14, 2010, Seattle, Washington

Abstracts

Scientific and educational abstracts presented at the ASER 2010 annual scientific meeting and postgraduate course August 11–14, 2010, Seattle, Washington     

Effects of temperature,relative humidity,and dose rate on the sensitivity of cellulose triacetate dosimeters to electrons and γ-rays

Cellulose triacetate (CTA) films are useful dosimeters for radiation processing with γ rays and electron beams, and are usually analyzed by u.v. spectrophotometry. The radiation sensitivity of CTA film material increases linearly with both temperature (around room temperature) and relative humidity (between 20 and 80% r.h.) when irradiated at lower dose rates typical for ⁶⁰Co γ-ray irradiation (< 100 kGy h⁻¹). On the other hand, the response depends neither on temperature up to 45°C nor on relative humidity of the surrounding atmosphere during irradiation at high dose rates above 1 MGy h⁻¹, which are typical for electron irradiation. In fact, the extent of temperature dependence and humidity of response are markedly influenced by dose rate. There are also appreciable influences of temperature and relative humidity changes during the post-irradiation storage, but in this case there is no difference of storage effect for different dose levels. The thickness of CTA film influences the dose-rate dependence in the range between 10 kGy h⁻¹ and 1 MGy h⁻¹, but not the dependence on temperature during irradiation. Other environmental influences on the sensitivity were also examined, for the purpose of evaluating systematic uncertainties due to these effects in practical dosimetry.     

Ehlers–Danlos syndrome type IV and recurrent carotid-cavernous fistula: review of the literature, endovascular approach, technique and difficulties

We report the follow-up of a previously published case (Forlodou et al. Neuroradiology 38:595–597, 1996) of carotido-cavernous fistulas (CCFs) in a patient presenting with type IV Ehlers–Danlos syndrome (EDS 4) that were successfully treated twice by an endovascular approach. Initial treatment with a detachable balloon was in 1994 for a right CCF, and, 8 years later, a left CCF was treated by selective transarterial occlusion of the cavernous sinus with coils. Unfortunately, the patient suffered from a spontaneous post-operative intracranial haemorrhage in the left hemisphere and died. Review of the literature, technical considerations for bilateral CCF and complication are discussed.     

Scientific and Educational Abstracts Presented at the ASER 2011 Annual Scientific Meeting and Postgraduate Course September 14–17, 2011, Key Biscayne,Florida

Abstracts

Scientific and Educational Abstracts Presented at the ASER 2011 Annual Scientific Meeting and Postgraduate Course September 14–17, 2011, Key Biscayne, Florida