Repetitive strain injuries

The semimechanized and repetitive nature of industry, the greater use of keyboards, and the need to boost production during an economic recession have led to a huge increase in repetitive strain injuries. The types of injury, their diagnosis and their treatment are discussed.     

Repetitive strain injury

Repetitive strain injury is a group of musculoskeletal disorders affecting muscles, tendons, nerves and blood vessels. These disorders could be attributed to occupational causes; however non-occupational causes should be excluded. The management of these cases required a multidisciplinary team approach.     

Repetitive strain injury

Pain in the forearm is relatively common in the community. In the workplace forearm pain is associated with work involving frequent repetition, high forces, and prolonged abnormal postures. Nevertheless, other factors are involved in the presentation and the continuation of the pain. Notable among these factors are psychosocial issues and the workplace environment-the attitude to workers and their welfare, the physical conditions, and design of the job. Primary prevention may be effective but active surveillance is important with early intervention and an active management approach. Physical treatments have not been extensively evaluated. In the established case, management should be multidisciplinary, addressing physical aspects of the job but also addressing the "yellow, blue, and black flags" which should be viewed as obstacles to recovery. For the worker "on sick" a dialogue should be established between the worker, the primary care physician, and the workplace. Return to work should be encouraged and facilitated by medical interventions and light duty options. Rehabilitation programmes may be of use in chronic cases.     

重复异位妊娠的保守治疗

目的：探讨重复异位妊娠保守治疗法。方法：22例非破裂重复异位妊娠均采用MTX静脉化疗，其中5例加用米非司酮治疗。结果：22例重复异位妊娠保守治疗全部成功，其中15例一个疗程MTX化疗血β－HCG下降至正常，2例两个疗程MTX化疗痊愈，5例第2个疗程联合米非司酮治疗成功。结论：采用MTX静脉化疗或联合米非司酮治疗重复异位妊娠是简单易行的方法。     

重复神经电刺激在重症肌无力中的临床应用研究

目的　探讨重复神经电刺激 (RNS)对重症肌无力 (MG)的临床应用价值。方法　对 3 0例MG患者的面神经、副神经、腋神经、尺神经分别用低频 (3Hz、5Hz)和高频 (10Hz、15Hz、2 0Hz)超强电流进行RNS检查 ,共检查 12 0条神经。所检神经对应的肌肉疲劳后 ,再以上述频率和电流重复进行RNS检查。结果　低频刺激阳性为 5 6.67% (17/ 3 0 ) ,高频刺激阳性为 2 6.67% (8/ 3 0 ) ,两者比较差异有高度显著性 (P <0 .0 0 1)。 10 0 %RNS阳性患者在低频刺激时即可获得阳性结果。疲劳前的RNS阳性率为 5 6.67% (17/ 3 0 ) ,疲劳后为 83 .3 3 % (2 5 / 3 0 ) ,两者比较差异有显著性 (P <0 .0 5 )。疲劳后按 4块肌肉统计RNS阳性率为 86.67% (2 6/ 3 0 ) ,而按 3块肌肉统计阳性率为 60 .0 0 % (18/ 3 0 ) ,两者比较差异有显著性 (P <0 .0 5 )。结论　低频RNS检查在MG疾病诊断中具有重要的价值 ,对MG患者的临床分型和指导治疗具有重要意义 ,受检神经所支配的肌肉疲劳后和增加检查的神经数目能提高RNS阳性率。     

Repetitive pseudoseizures incorrectly managed as status epilepticus.

Pseudoseizures should be considered in the differential diagnosis of intractable seizures. Incorrect diagnosis may result in incorrect management, with the patient unnecessarily exposed to side effects of drugs. The authors report on three patients who presented with uncontrolled seizures originally diagnosed and managed as status epilepticus. Electroencephalography performed during provoked attacks led to a diagnosis of pseudoseizures. Psychiatric assessment revealed psychologic disorders. The patients received supportive therapy, and the pseudoseizures stopped.     

Hunting-related injuries

One hundred four patients treated for injuries incurred while hunting were prospectively studied during two consecutive fall seasons. A questionnaire was completed at initial evaluation and hospital records were subsequently reviewed. One hundred (98%) patients were male. Patient ages ranged from 10 to 78 years (median = 32 years). Mechanism of injury included knife or arrow penetrations (25), firearm wounds (12), falls (17), overexertion (5), and misadventures with hazards (40). Soft tissue, maxillofacial and orthopedic injuries predominated. Four patients experienced cardiac events. Hypothermia was noted in three, and animal-related injuries occurred in five. Eighteen (17%) patients were hospitalized. Serious injury was evident in 34 (33%). There were no deaths. Outpatient follow-up was necessary in 90%. Mishaps most frequently occurred because of overexcitement, unfamiliarity with equipment, or carelessness. Alcohol and drug use were only rarely identified. Almost one half of patients were injured during the 9-day gun deer hunting season. A wide variety of injuries occur during hunting activities. While many are minor, serious morbidity with potential long-term disability may result. Costs in time and money may be substantial. Simple measures could prevent many hunting-related mishaps.