National Athletic Trainers' Association Position Statement: Acute Management of the Cervical Spine–Injured Athlete

Objective:

To provide certified athletic trainers, team physicians, emergency responders, and other health care professionals with recommendations on how to best manage a catastrophic cervical spine injury in the athlete.

Background:

The relative incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, often involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and the timeliness of transfer to a controlled environment for diagnosis and treatment.

Recommendations:

Recommendations are based on current evidence pertaining to prevention strategies to reduce the incidence of cervical spine injuries in sport; emergency planning and preparation to increase management efficiency; maintaining or creating neutral alignment in the cervical spine; accessing and maintaining the airway; stabilizing and transferring the athlete with a suspected cervical spine injury; managing the athlete participating in an equipment-laden sport, such as football, hockey, or lacrosse; and considerations in the emergency department.     

p.R254Q mutation in the aquaporin‐2 water channel causing dominant nephrogenic diabetes insipidus is due to a lack of arginine vasopressin‐induced phosphorylation

Vasopressin regulates human water homeostasis by re‐distributing homotetrameric aquaporin‐2 (AQP2) water channels from intracellular vesicles to the apical membrane of renal principal cells, a process in which phosphorylation of AQP2 at S256 by cAMP‐dependent protein kinase A (PKA) is thought to be essential. Dominant nephrogenic diabetes insipidus (NDI), a disease in which the kidney is unable to concentrate urine in response to vasopressin, is caused by AQP2 gene mutations. Here, we investigated a reported patient case of dominant NDI caused by a novel p.R254Q mutation. Expressed in oocytes, AQP2‐p.R254Q appeared to be a functional water channel, but was impaired in its transport to the cell surface to the same degree as AQP2‐p.S256A, which mimics non‐phosphorylated AQP2. In polarized MDCK cells, AQP2‐p.R254Q was retained and was distributed similarly to that of unstimulated wt‐AQP2 or AQP2‐p.S256A. Upon co‐expression, AQP2‐p.R254Q interacted with, and retained wt‐AQP2 in intracellular vesicles. In contrast to wild‐type AQP2, forskolin did not increase AQP2‐p.R254Q phosphorylation at S256 or its translocation to the apical membrane. Mimicking constitutive phosphorylation in AQP2‐p.R254Q with the p.S256D mutation, however, rescued its apical membrane expression. These date indicate that a lack of S256 phosphorylation is the sole cause of dominant NDI here, and thereby, p.R254Q is a loss of function instead of a gain of function mutation in dominant NDI. © 2009 Wiley‐Liss, Inc.     

Effects of preterm birth and fetal growth retardation on cardiovascular risk factors in young adulthood

Background

The association between low birth weight (LBW) and increased risk of obesity, hypertension and cardiovascular disease later in life is well documented in epidemiological studies. However, clinical follow-up studies of LBW populations have only partly supported this.

Aims

Evaluate associations between LBW and body fat, blood pressure (BP), lung and endothelial function, and maximal oxygen uptake (VO_2max) in 18 year old young adults.

Subjects

Thirty-seven subjects born prematurely with birth weight < 1501 g (VLBW group), 47 born at term with low weight (< 10th centile) for gestational age (SGA group) and 63 controls with normal birth weight participated in the study.

Outcome measures

Anthropometric measurements, BP, endothelial function, lung function and VO_2max were recorded.

Results

Both LBW groups were shorter, lighter, had smaller head circumference and higher subscapular-to-triceps skinfold-ratio than controls. Systolic and mean arterial BP was higher in the VLBW compared with the control group, whereas there were no differences between the groups in endothelial function. The VLBW group had reduced dynamic lung volumes lower carbon monoxide transfer factor and lower VO_2max compared with controls. In particular young adults born VLBW who were also growth retarded in utero had higher indices of central body fat, higher BP and lower VO_2max.

Conclusion

We found that very preterm birth, but not growth retardation at term, was associated with higher BP and a less favourable fat distribution. In particular, the young adults born VLBW who were also growth retarded in utero had less favourable outcomes.     

Laparoscopic resection of benign ovarian tumours in children with gonadal preservation

Purpose  Ovarian tumours are often regarded as an indication for open oophorectomy, especially following torsion. We wish to report our results of laparoscopic ovarian cystectomy with ovarian preservation. Methods  Retrospective review of clinical records of patients who where managed with laparoscopic ovarian cystectomy with ovarian preservation. Results  Twelve records were identified over a 3-year period. The average age was 11.8 years (9–15). Presentation was of a mass in nine patients and torsion in three patients. Average size of the mass was 8.2 cm (5–18). Two patients had bilateral lesions. All patients were noted to have normal tumour markers. Successful cystectomy with ovarian preservation was accomplished in all cases using 3-port laparoscopy. The bilateral lesions were addressed at the same surgery with no increased length of stay or morbidity. In the three patients with acute torsion, an initial laparoscopic detorsion was performed with delayed laparoscopic cystectomy and ovarian preservation 7–10 days later. There was one complication of a minor umbilical port site infection. Histology was of a mature teratoma in ten cases and simple cyst in two. Six patients underwent routine ultrasonographic follow-up at 2–5 months at which time the involved ovary assumed a size and shape and blood flow comparable to the contra-lateral ovary in five patients. In one patient the affected side was smaller, 8.6 ml compared to 10 ml on the contra-lateral ovary. The remaining patients have been followed up clinically and remain asymptomatic. Conclusion  Laparoscopic cystectomy with ovarian preservation can be successfully applied to benign ovarian tumours. Acute ovarian torsion is not a contraindication to this technique where a two stage procedure still enables us to offer ovarian preservation.     

Investigation of the PGNAA using the LaBr3 scintillation detector

The Joint Research Centre of the European Commission develops instrumentation for detection of hazardous materials. In relation to this a new experimental facility was constructed for research into methods applying the detection of characteristic gamma rays subsequent to neutron irradiation. This includes the detection of prompt gamma rays from neutron inelastic scattering and neutron capture. For this purpose the device employs LaBr₃ scintillation detectors. The paper investigates the applicability of the LaBr₃ scintillation detector to PGNAA.     

Tunnel positioning in anterior cruciate ligament reconstruction: how long is the learning curve?

The purpose of this study is to investigate the effect of the learning curve on radiographic tunnel position. A consecutive series of the first 200 procedures of an orthopaedic surgeon over his initial 4 years of independent practice were analysed for tunnel placement, based on radiographic appearance. An arthroscopic-assisted technique using patella tendon as graft material was performed in all cases. To establish femoral tunnels, a transtibial guide pin was used. The graft was secured with bioabsorbable screws. A Frik tunnel view and a strictly lateral radiograph were used to assess tunnel placements. Tunnel positioning was assessed using a computer-aided design, 2D software (Auto CAD2000^®). To minimize measurement bias, radiographs were assessed three times or until deviations in all three measurements were less than 10%, and the three measurements were then averaged. Sagittal femoral tunnel placement improved significantly (P = 0.01) after the first 100 cases. Significant improvement (P = 0.05) in coronal femoral tunnel placement was observed after the first 75 cases. Significant improvement (P = 0.01) in sagittal tibial tunnel position was observed after the first 100 cases. Mean coronal tibial tunnel did not improve. Critical analysis in this consecutive series suggests that a caseload of approximately 100 procedures were necessary for this surgeon to refine his surgical technique beyond that acquired during formal training.