Thoracic venous injuries: an imaging and management overview

Thoracic venous injuries are predominantly attributed to traumatic and iatrogenic causes. Gunshot wounds and knife stabbings make up the vast majority of penetrating trauma whereas motor vehicle collisions are the leading cause of blunt trauma to the chest. Iatrogenic injuries, mostly from central venous catheter complications are being described in growing detail. Although these injuries are rare, they pose a diagnostic challenge as their clinical presentation does not substantially differ from that of arterial injury. Furthermore, the highly lethal nature of some of these injuries provides limited literature for review and probably underestimates their true incidence. The widespread use of multi-detector computed tomography (MDCT) has increased the detection rate of these lesions in hemodynamically stable patients that survive the initial traumatic event. In this article, we will discuss and illustrate various causes of injury to each vein and their supporting CT findings while briefly discussing management. The available literature will be reviewed for penetrating, blunt, and iatrogenic injuries to the vena cava, innominate, subclavian, axillary, azygos, and pulmonary veins.     

Back injuries to fast bowlers in cricket: a prospective study.

Eighty-two high performance young male fast bowlers (mean age 16.8 years) were tested immediately prior to the season for selected kinanthropometric and physiological data. Subjects were also filmed both laterally (200 Hz) and from above (100 Hz) while bowling so that their front foot impacted a force platform during the delivery stride. The players then completed a log book over the ensuing season that detailed their training and playing programmes. All cricket related injuries over this season were assessed by a sports physician who used computerized tomography to assist in the diagnosis of spinal injuries. At the completion of this season the players were grouped according to their injury status (Group 1--bony injury to a vertebra; Group 2--soft tissue injury to the back that caused the player to miss at least one game, and Group 3--no injuries). A one-way analysis of variance was used to identify if any variables were significantly (P less than 0.05) different between the three groups, and a Scheffe post hoc comparison was used to determine which groups were significantly different. Eleven per cent of the players sustained a stress fracture to a vertebra(e) (L4 to S1), while 27 per cent sustained a soft tissue injury to the back. Bowlers with a low longitudinal foot arch were more likely to develop a stress fracture than those with a high arch. Shoulder depression and horizontal flexion strength for the preferred limb and quadriceps power in the non-preferred limb were also significantly related to back injuries. Results suggest that bowlers with the above physical characteristics, who bowl with these biomechanical techniques for extended periods, are predisposed to back injuries.     

Severe eye injuries in cricket.

We report five cases of severe eye injury sustained in cricket, including retinal detachment and rupture of the globe. The eye is at particular risk from a rising ball. We comment on the need for appropriate facial protection for batsmen and close fielders.     

Measures used to treat contrast-induced nephropathy: overview of reviews

Objectives

Despite many interventions that have been tried, controversy remains regarding the efficacy of interventions for contrast-induced nephropathy (CIN), so we aimed to evaluate the best evidence from recent meta-analyses.

Methods

We searched MEDLINE, EMBASE and the Cochrane library for interventions which have been used for CIN. We included only the most recent meta-analysis of each intervention. We extracted data on the methodology, quality and results of each meta-analysis. We performed narrative synthesis and adjusted indirect comparison of interventions that were shown to be statistically significant compared with a placebo.

Results

We included 7 systematic reviews and meta-analyses involving 9 different interventions for CIN, with a total of 15 976 participants. A significantly decreased risk of CIN was reported in meta-analysis of the following interventions: N-acetylcysteine [odds ratio (OR) 0.65, 95% confidence interval (CI) 0.48–0.88, I²=64%], theophylline [relative risk (RR) 0.48, 95% CI 0.26–0.89, I²=44%], statins (RR 0.51, 95% CI 0.34–0.77, I²=0%) and sodium bicarbonate (RR 0.62, 95% CI 0.45–0.86, I²=49%). Furosemide was shown to increase the risk of CIN (RR 3.27, 95% CI 1.48–7.26, I²=0%). Other interventions such as renal replacement therapy, angiotensin-converting enzyme inhibitors, dopamine and fenoldapam failed to show any significant difference from the control group.

Conclusion

Although there is some evidence to suggest that N-acetylcysteine, theophylline, sodium bicarbonate and statins may reduce incidence of CIN, limitations in the study quality and heterogeneity preclude any firm recommendations.

Advances in knowledge

N-acetylcysteine, theophylline, sodium bicarbonate and statins show some promise as potentially efficacious agents for preventing CIN, but more high-quality studies are needed before they can be recommended for use in routine practice.Contrast-induced nephropathy (CIN) is a well-recognised complication of contrast administration and the third leading cause of hospital-acquired acute kidney injury [1]. Despite some heterogeneity in definition, CIN is generally defined as an increase in serum creatinine over 25% or 44 μmol l⁻¹ from baseline value 48–72 h after contrast media administration in the absence of any other aetiology [2]. CIN occurs in 0–10% of patients with normal renal function and in up to 25% of patients with pre-existing renal disease or certain risk factors such as diabetes, advanced age or nephrotoxic drugs [3]. A recent meta-analysis of 40 studies found that the pooled incidence of CIN was 6.4% after CT scanning [4].The pathophysiology of CIN is not completely understood but it is believed that contrast media causes vasoconstriction and renal medulla ischaemia, which leads to generation of free radicals and oxidative injury to tubular cells [5-8]. Studies have demonstrated that CIN is associated with increased in-hospital length of stay, morbidity and mortality and increased cost of medical care, especially in patients who require dialysis [9].A number of measures (hydration methods and physical agents) have been tried to prevent or treat contrast nephropathy. Hydration methods include N-acetylcysteine (NAC) and sodium bicarbonate. Studies have explored the value of NAC for contrast nephropathy and some have found that its use is associated with clinical benefits [10-13], but a recent large randomised trial found no such benefit associated with NAC use [14]. A number of published studies have suggested that bicarbonate is superior to saline in contrast-induced nephropathy [15-18]. However, there are also a number of unpublished studies which suggest no benefit associated with sodium bicarbonate use [19,20]. Theophylline and other drugs are methods that have been tried to reduce CIN. Theophylline has been shown to be protective in CIN in a few studies [21,22] but other studies have found no difference between theophylline and a control [23,24]. In addition, many drugs have been tried to prevent CIN [25-27].In response to the many studies, a number of meta-analyses have been published which have evaluated different measures used for CIN [28,29]. We reviewed the literature to identify these meta-analyses in order to determine the most up-to-date evidence on each intervention for CIN.     

Training and equipment to prevent athletic head and neck injuries

Due to the potential for catastrophic neurotraumas and cervical spine injuries in sport, the sports health care professional must take proper measures to prevent such injuries. Strength training of the cervical spine, teaching of proper sporting techniques, and use of protective sports equipment are three primary means of attempting to prevent neurotraumas and cervical spine injuries in sports. There are other avenues to assist in preventing these injuries, such as flexibility programs. The sports health care professional, therefore, must be knowledgeable of the needs of each individual athlete when developing prevention plans.     

Match injuries in Sri Lankan junior cricket: A prospective,longitudinal study

ObjectivesUnderstanding the nature of injuries in cricket is key to mitigate injury risks and prioritise preventive measures. This study aimed to identify the incidence and nature of match injuries among Sri Lankan junior cricketers.DesignLongitudinal follow-up study with prospective in-season data collection.MethodsA national survey of schoolboy, division-1 cricket teams in under-15 and under-17 age groups. Using a paper-based questionnaire, distributed to school-teams at the start of the 2016 cricket season, respondents recorded any injuries, including the site, type and mechanism. Match injury incidence rates (match-IIR) (injuries/100 match-player-days) were calculated overall, by position and for match time loss (MTL) and non-MTL injuries.ResultsFrom 59 school-teams, 573 players responded, with 404 players reporting 744 injuries in 648 matches. The match-IIR was 28.0 injuries/100 match-player-days (95% CI = 26.0–30.2). The highest match-IIR was reported among fielders (46.0% of all injuries sustained; match-IIR = 12.9) compared with batters (25.4%; match-IIR = 7.1) and bowlers (20.3%; match-IIR = 5.7). Abrasions and bruises to the knee or elbow were the most common injuries among fielders, with the majority being non-MTL injuries.ConclusionsAlmost half (46.0%) of all injuries were to fielders, and more research into their severity and mechanisms is needed to identify the need for, and design of, preventive measures. Batters sustained a relatively large number of facial-organ injuries from being struck by the ball, presenting a need to evaluate the use and appropriateness of helmets by Sri Lankan junior cricketers. Similar to other junior cricket studies, the most common injuries among bowlers were strains and sprains, mainly affecting the lower limbs and lower back.     

Hamstring injuries in England and Wales elite men's domestic cricket from 2010 to 2019

ObjectivesDescribe hamstring injury incidence across competition formats, activity at time of injury, and time of season, facilitating the identification of injury risk factors in elite men's senior First-Class County Cricket.DesignProspective cohort.MethodsHamstring time loss injury incidence (between format, activity, and time of season) calculated for elite men's senior First-Class County Cricket seasons 2010 to 2019.ResultsThe diagnosis with the highest seasonal incidence was ‘Biceps femoris strain grade 1–2’ (2.5 injuries/100 players). Hamstring injury incidence was highest in One-Day cricket (mean 27.2 injuries/1000 team days). Running between wickets when batting was the activity associated with the highest incidence in the shorter competition formats (8.4 and 4.8 injuries/1000 team days for One-Day and T20, respectively). Bowling delivery stride or follow through was the activity with the highest incidence for longer multi-day Test format (mean 2.3 injuries/1000 team days), although similar incidence was observed across all formats for this activity. Most injuries were sustained at the start of the season (April; 22.7 injuries/1000 team days), with significantly fewer injuries at end of the season (September; 4.1 injuries/1000 team days).ConclusionsSimilar bowling injury incidence across formats suggests hamstring injury risk is associated more with the activity itself, whereas injury risk when batting was susceptible to changes in match intensity. The notably higher (albeit non-significant) incidence in April may allude to a lack of preparedness to meet the physical demands of the start of the season. The findings have practical relevance for practitioners, identifying potential opportunities for preventative strategies.     

An overview of hip injuries in running

Running has steadily gained in worldwide popularity and is the primary exercise modality for many individuals of all ages. Its low cost, versatility, convenience and related health benefits appeal to men and women of broad cultural, ethnic and economic backgrounds. With more children and adults participating in recreational and competitive running, the incidence of injuries has steadily increased. Most running-related injuries affecting the lower extremities are due to preventable training errors, and some may necessitate medical evaluation or a significant reduction in training.Hip injuries in runners are due to interactions of intrinsic and extrinsic factors that adversely affect the complex regional anatomy. Acute or chronic hip pain presents a diagnostic and therapeutic challenge because the vague, nonspecific symptoms and signs may originate from local, regional or distant foci. Muscle strains and tendonitis are the most common aetiologies of hip pain and typically result from sudden acceleration/deceleration manoeuvres, direction changes or eccentric contractions. Apophysitis and avulsion fractures may affect younger runners and produce localised pain at muscle attachment sites. Iliotibial band syndrome is a common cause of lateral hip and knee symptoms characterised by sharp or burning pain that is exacerbated by activity. Bursitis, due to repetitive activity or acute trauma, may affect the trochanteric, ischial or iliopectineal bursae. Hip osteoarthritis may also produce persistent pain that worsens with running. Stress fractures are potentially serious conditions that affect women more frequently than men. Snapping hip syndrome is a benign condition that results from tight connective tissues' passing repeatedly over the greater trochanter, anterior hip capsule, lesser trochanter, femoral head or iliopectineal eminence. Acetabular labral tears, sports hernias and nerve entrapment syndromes are also potential causes of persistent hip pain in runners.Treatment of hip pain in running should focus not only on addressing the symptoms but also identifying the underlying conditions that precipitated the injury. Injury prevention and comprehensive rehabilitation are essential, since prior hip injuries increase the risk of subsequent ones. Coaches, trainers and medical personal who care for runners should advocate running regimens, surfaces, shoes, technique and individualised conditioning programmes that minimise the risk of initial or recurrent hip injuries.     

Computed tomography: an overview

Instrumentation for computed tomography (CT) can be put into three categories that are defined in this article. The basis for this categorization depends on the number of detectors and the type of scanning mode used by each. The goal of each generation scanner is to provide a measurement of x-ray absorption coefficients of cross-sectional portions of the anatomy. The technology of each generation is also presented.