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Biomedical subjects

N Maffulli

Publications and source records attributed to N Maffulli.

At least 163 records · Page 9Linked to original sources
PubMed1996

Antibiotic prophylaxis: theory and reality in orthopaedics.

Marked differences were found when prophylactic antibiotic regimens and accuracy of administration were compared in the orthopaedic trauma and elective surgery units of one city. Consultants carrying out elective, primary joint replacements advocated similar antibiotic policies. There was 100% compliance in correct prescription and over 99% in administration of antibiotic doses. An audit of eight surgeons who undertook emergency surgery on adult hip fractures found three different prophylactic antibiotic regimens and that half of the consultants wished no antibiotics to be given. Only 33% of the patients were prescribed the schedule that their consultant wished and there were frequent inaccuracies in dose administration. Of 48 doses prescribed, five were omitted and in addition, four were recorded as having been given although they were unprescribed. Whilst antibiotic prophylaxis is universally accepted and the drugs are prescribed and administered accurately in cases of elective joint arthroplasty, the converse is true for emergency hip surgery.

Adult↗
PubMed1995

Ultrasonographic appearance of external callus in long-bone fractures.

High-resolution real-time ultrasound (US) scanning was used to monitor serially 24 patients with an acute long-bone fracture and three patients with humeral non-union, looking at the fracture site over a period of 12 months following the fracture. In both these groups, we found that US gave important information about the soft tissues surrounding the fracture site, and indicated callus formation at an early stage. US was more sensitive than conventional radiography at showing the early phases of organization of the callus, and its progression to bridging new bone formation. US also clearly showed a disorganized echopattern at the fracture site of the patients with non-union.

Adolescent↗
PubMed1995

Scapho-trapezoid arthritis. A cause of residual pain after arthroplasty of the trapezio-metacarpal joint.

Scapho-trapezoid osteoarthritis may accompany osteoarthritis of the CM joint of the thumb. If the scapho-trapezoid joint is not excised when performing an excision of the trapezium with ligament reconstruction and interposition of the tendon of the FCR, the procedure may be unsuccessful. We describe three patients with four thumbs in which scapho-trapezoid osteoarthritis was associated with basal joint arthritis. In one patient, it was not recognized pre-operatively and persistent post-operative pain dictated further surgery. In the other patients, the scapho-trapezoid joint was excised primarily, with resolution of the pain. In the pre-operative assessment, the scapho-trapezoid joint should be carefully studied to prevent failure of the procedure.

Aged↗
PubMed1995

Traumatic dislocation of the lateral sesamoid of the great toe: nonoperative management.

A case of traumatic dislocation of the lateral sesamoid of flexor hallucis brevis tendon associated with metatarsal neck fractures due to a crush injury is reported. This patient was treated nonoperatively by elevation, application of plaster, and then free mobilisation. The patient has now fully recovered and remains completely asymptomatic despite residual sesamoid dislocation 1 year after the injury. The nonoperative management of this injury has not, to our knowledge, been reported previously.

Adult↗
PubMed1995

Common skeletal injuries in young athletes.

The increasing frequency of injury in young athletes over the last 2 decades reflects the increases in sports participation of children of a young age. Physical injury is an inherent risk in sports participation at any age. In general, the factors causing sports injuries can be grouped in 2 separate broad categories: extrinsic and intrinsic factors. However, the great majority of injuries which are sustained are minor and self-limiting, suggesting that children and youth sports are safe. However, a increasing number of children undergo treatment because of the effects that injuries may have on their developing bodies. A child's skeletal system shows pronounced adaptive changes to intensive sports training. Sports injuries affect both growing bone and soft tissues, and could result in damage of the growth mechanisms with subsequent life-lasting damage. Adolescents are particularly vulnerable to injuries, at least partially due to an imbalance in strength and flexibility. During growth there are significant changes in the biomechanical properties of bone. In young athletes, as bone stiffness increases and resistance to impact diminishes, sudden overload may cause bones to bow or buckle. Epiphyseal injuries occur at the epiphyseal growth plates. They are usually due to shearing and avulsion forces, although compression also plays a significant role. Given the remarkable healing potential of bone in youngsters, fractures that initially united with some deformity can completely remodel and appear totally normal in later life. As the risk of injuries sustained by young athletes can be significant, it is essential that training programmes take into account their physical and psychological immaturity, so that the growing athlete can adjust to their own body changes.

Adolescent↗
PubMed1995

Reproductive hormones and menstrual changes with exercise in female athletes.

The endocrine equilibrium which regulates reproductive function in women can be affected by physical and psychological factors. Blood levels of hormones depend on a balance between production, metabolism and clearance rates. Intensive physical exercise may affect this balance via different mechanisms, such as stress associated with competition, dieting, reduction of body fat and body weight, production of heat or hypoxia. Women who engage in regular high intensity exercise may be at risk, as a consequence of these hormonal changes, of developing menstrual disturbances such as oligomenorrhoea, delayed menarche and amenorrhoea. Impaired production of gonadotrophins, which leads to luteal phase deficiency and anovulation, is a common hormonal finding with exercise-induced menstrual disturbances, but several other hormones may show significant alterations. In this article we have reviewed the recent literature on the effects of intensive physical exercise on the menstrual cycle, on some important physical parameters such as bone mineral density and bodyweight, and on those hormones (gonadotrophins, prolactin, melatonin, opioid peptides and steroids) which regulate, directly or indirectly, the reproductive function in women.

Bone Density↗
PubMed1995

Traumatic release of Dupuytren's contracture.

A case of partial traumatic division of a Dupuytren's band in a 56-year-old man with known Dupuytren's disease is described. Management consisted of exploration of the wound and limited fasciectomy, with excision of the diseased fascia, the pretendinous band, the lateral cord and the spiral cord. Postoperative recovery was uneventful, and the patient returned to work. He remains well two years after the injury.

Dupuytren Contracture↗
PubMed1995

Osteoid osteoma of the clavicle.

We describe a case of osteoid osteoma of the clavicle in an Olympic free-style wrestler who presented to us with persistent and increasingly elevated pain in his right shoulder. Originally a persistent injury was considered to be causing the pain, however, the correct diagnosis was made three months after the onset of the symptoms. Even in sportsman where muscle pain is commonplace, non-traumatic conditions should be considered in the presence of persistent and increasingly elevated pain that is not relieved by rest and physiotherapy.

Adult↗
PubMed1995

Quasi-synchronous patellar tendon rupture.

The case of a 66-year-old male who suffered from rupture of both patellar tendons within a few minutes of each other is reported. The patient was not suffering from any underlying medical problems, and made an uneventful recovery following surgical repair.

Aged↗
PubMed1995

Acute abdomen: an atypical presentation of pubic osteomyelitis.

A 67-year-old woman was admitted with diffuse lower abdominal and suprapubic pain, with diastasis of the pubic symphysis. She developed an acute abdomen necessitating an exploratory laparotomy. During laparotomy, the pubic lesion was explored, and histology confirmed the diagnosis of pubic osteomyelitis and the presence of Staphylococcus aureus. The patient recovered fully with a four-week course of antibiotic therapy. This case confirms the protean presentation of pubic osteomyelitis, alerting physicians of the necessity to institute prompt treatment is such cases.

Abdomen, Acute↗
PubMed1994

Treadmill exercise in Neopolitan children and adolescents.

Two hundred and eighty healthy children from Naples, Italy (140 boys and 140 girls) aged 4-17 years were studied using Bruce walking treadmill protocol to voluntary exhaustion. Endurance time and double product increased with age. Systolic blood pressure increased linearly during the test. Multivariate analysis showed that body weight and age were the best predictors of endurance time. Endurance time averaged 15.2 +/- 2.8 min in boys and 13.7 +/- 2.3 min in girls (p = 0.00001). Mean +/- SD double product at peak exercise was 264.3 +/- 63 (boys) and 242 +/- 44 (girls) (p = 0.01). Sinus arrhythmia was present in 78% of the children and disappeared at a mean heart rate of 112 +/- 16 beats/min during exercise. The voltage of the R wave on V4 lead decreased in all but four children during the test (delta R = -0.25 +/- 0.24 mV). The P and T waves increased in almost all children. No ST depression or upward sloping was detected. The voltage of the PR isoelectric line remained constant. The J point was displaced downwards in 78% of children, unchanged in 11% and displaced upwards in the remaining 11% of the children. The present study gives reference parameters for a walking treadmill test in Southern European children.

Adolescent↗
PubMed1994

Training in élite young athletes (the Training of Young Athletes (TOYA) Study): injuries, flexibility and isometric strength.

Using a mixed longitudinal design, the incidence of injuries, and the development of flexibility and isometric strength of the upper and lower limbs were studied for 2 years in 453 élite young athletes (aged between 9 and 18 years) practising football, gymnastics, swimming or tennis. The children suffered from a low incidence of injuries. Strength and flexibility did not exert a significant role in determining injuries. The rate of injury was not significantly different between the 2 years of the study. Young swimmers showed a greater generalized flexibility. Girls were more flexible than boys between the ages of 13 to 16 years. Athletic children are able to exert greater isometric strength than normal schoolchildren. Boys diverged from the normal population at 14 years, while athletic girls were stronger at all ages. Girls were stronger than boys up to age 12, who were still increasing their muscle strength at 19 years. The average maximal isometric strength exerted in both upper and lower limbs in the four sports was not significantly different. Male gymnasts over 11 years old were significantly stronger than all other athletes.

Adolescent↗
PubMed1994

An epidemiological investigation of training and injury patterns in British triathletes.

During the competitive season of 1990, 155 British triathletes whose competitive distances varied from sprint to full ironman, and who self-classified themselves as recreational, intermediate or élite, kept a training diary for an 8-week period. They gave details of injuries sustained while training for, or competing in, triathlons. The mean(s.d.) distances covered each week were: swimming, 4.2(2.6) km; cycling, 100.2(70.6) km; and running 23.4(15.2) km; mean(s.d.) training time was 7(3.4) h per week, and a mean(s.d.) of 7.9(3.4) training sessions were completed per week. At least one injury was reported by 37% of the participants. The most frequently affected sites were the ankle/foot, thigh, knee, lower leg and the back. Overuse was the reported cause in 41% of the injuries, two-thirds of which occurred during running. The likelihood of an injury was positively associated with experience in triathlon. Average injury rate was 5.4 injuries per 1000 h of training (95% confidence interval: 4-7.2) and 17.4 per 1000 h of competition (95% confidence interval: 10.9-27.9). Injury incidence was unrelated to the mean amount of weekly training or competition, intensity or frequency of training.

Adult↗
PubMed1994

Anaerobic threshold determination in master endurance runners.

Twenty middle aged endurance runners underwent physiological testing to determine their maximal oxygen uptake (VO2max), lactate threshold, ventilatory threshold, the slope variation point (SVP) of the linear relationship between running speed (RS) and heart rate (HR) both on the treadmill and during a field test, and the onset of blood lactate accumulation point. The RS, HR, VO2 and blood lactate concentration at which the different thresholds occurred were highly correlated (0.70 < r < 0.95; p < 0.01). The various indices of aerobic-anaerobic transition in the master athletes examined were shown to occur at a comparable percentage of their VO2max as compared to their younger counterparts. The tests developed for, and commonly used in adult athletes, are equally valid in this age group.

Aged↗