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A survey of new jersey high school football officials regarding spearing rules.

Football officials play an important role in the prevention of catastrophic head and neck injuries. Officials alone can use the spearing penalty as a deterrent to players during football games. The purpose of this study was to determine the officials' perspectives on the spearing rules and their level of enforcement. In a stratified random sample, 100 high school officials from New Jersey were surveyed. The officials returned 100% of the questionnaires. Each official worked an average of 27 games during 1992. Forty-seven percent of the officials did not call any spearing penalties. A New Jersey official called an estimated one spearing penalty in 20 games. The officials were most likely to call a spearing penalty on a late hit and least likely to call one on a ball carrier. The officials' opinions varied greatly regarding the spearing rules. The level of enforcement found in this study was extremely low. The possibility exists that officials are either overlooking or not recognizing a significant number of spears. Individual athletic trainers, state athletic training associations, and the National Athletic Trainers' Association should take steps to improve the enforcement level of the spearing penalty.

Journal Article↗

Spinal X-ray screening of high performance fighter pilots.

Neck pain and neck injury are common complaints among military aviators flying high performance (HPF) aircraft. Since all candidates for military flying training with the Royal Norwegian Air Force have to meet HPF medical standards, medical selection procedures include a radiological examination of the spine. Nine films of the vertebral column are made with emphasis put on cervical structures. Among 232 applicants, 527 deviations from normal conditions were described--anomalies, degenerative changes and deviations of posture--which average 2.27 diagnoses per spine X-rayed. Of the candidates, 80 were considered entirely within normal limits; 20 were rejected due to the roentgen findings; and five candidates were excluded on final evaluation, their radiological diagnoses contributing to the decision. Although most changes are slight, many significant conditions are demonstrated among young healthy individuals. Since the population is highly selected, the figures we present may be minimum numbers in a western industralized society.

Adult↗

Intermittent downbeat nystagmus secondary to vermian arachnoid cyst with associated obstructive hydrocephalus.

A 27-year-old man presented with a history of dizziness and intermittent vertical oscillopsia after oblique extension of the head and neck, following a neck injury 2 years previously. He had no other symptoms of cerebellar or brainstem dysfunction. On examination, an intermittent downbeat nystagmus lasting about fifty seconds was elicited by head extension and rotation. Radiologic examination showed slight lateral instability of the odontoid on lateral rotation, and computed tomography brain scan with Iopamidol 300 (Niopam) contrast revealed a 5-cm vermian arachnoid cyst in the posterior fossa with obstructive hydrocephalus. Removal of the cyst cured the nystagmus.

Adult↗

Isolated hyoid bone fracture: a case report and review of the literature.

Isolated hyoid bone fractures secondary to trauma other than strangulation are rare and have few, if any, complications. We report a case of an isolated hyoid bone fracture that resulted in sudden and severe upper airway compromise. Diagnosis of these fractures is difficult and usually can be made only with a strong degree of suspicion. Patients who suffer neck injuries in whom a hyoid fracture is diagnosed or strongly suspected should be observed for 48 to 72 hours, considered for endoscopy, and treated as warranted.

Accidents, Traffic↗

The treatment of sepsis and other complications in the trauma patient.

Immediate complications of trauma and shock include right heart failure, acute respiratory distress syndrome, coagulopathy, brain edema, small bowel dysfunction, renal failure, and immune dysfunction. Nosocomial infections are also common in trauma patients. These infections are the combined result of a compromised host defense and various iatrogenic risk factors, including the use of percutaneous drainage tubes, malnutrition, the injudicious use of prophylactic antibiotics, and treatment staff hygiene. The use of prophylactic antibiotics appears to be unwarranted in head, maxillofacial, and neck injuries and is debatable in chest and soft-tissue wounds, fractures, and injuries of the peritoneal cavity. The use of antibiotics in small bowel and colon injuries is justified. Antibiotics are necessary in crush or avulsive injuries. Combination antibiotic therapy often results in multiple complications that may compound the patient's problems. Therefore, a single antibiotic with minimal side effects is the therapy of choice in the surgical intensive care unit.

Animals↗

The role of exercise in the etiology of exertional heatstroke.

Exertional heatstroke usually occurs among healthy, fit individuals who are motivated to perform strenuous exercise because of peer pressure, discipline, or athletic competition. In fact, exertional heatstroke deaths among high school athletes in the United States (ranked third only to head and neck injuries and heart failures), and the reluctance of race directors to cancel or postpone mass participation road races during periods of severe heat and humidity, emphasize a continuing need for widespread dissemination of information. The purposes of this symposium are 1) to convey essential information to the members of ACSM who are involved in exercise prescription, patient care, or athletic training; and 2) to disseminate recent scientific theories and research concerning exertional heatstroke.

Body Temperature Regulation↗

Odontogenic sinus tracts.

Odontogenic sinus tracts are the most common cause of a chronically draining, fixed, nodulocystic papule of the face and neck. Injury or disease of a tooth may result in a periapical abscess that subsequently dissects along the path of least resistance and erupts through the skin. If recognized early, the sinus tract usually resolves after appropriate endodontic therapy or extraction.

Adult↗

An exploratory case-control study of brain tumors in children.

An exploratory case-control study of childhood brain tumors was conducted in southern Ontario between 1977 and 1983, on 74 cases and 138 age- and sex-matched population controls. A significantly elevated risk (perhaps due to early case symptoms) was seen for skull X-rays at least 5 years prior to diagnosis, and for head or neck injuries which required medical attention. However, no evidence of an increased risk appeared for exposure to sick pets or to pesticides, maternal or paternal history of smoking, and various birth characteristics or antenatal exposure of the child, though these have previously been reported to be associated with childhood brain tumors. With respect to the hypothesis that N-nitroso compounds may be involved in the etiology of childhood brain tumors, most exposures of this type were not associated with risk, though a significant positive association was seen for consumption of beer by the mother during pregnancy, and a significant negative association was seen with consumption of fruit juice by the child. Other findings in the present study include an association with developmental problems relating to height and weight and with certain socioeconomic characteristics of the mother. Further investigation of these results in future studies is warranted.

Adolescent↗

[Non-fatal firearm injuries of the head and neck].

There is depicted the evolutive course of 6 men with gunshot wounds of the neck and head, fortunately not threatening their lives. All victims were men between 18 and 67 years of age. Three times the gun fired a single projectile, whereas the other 3 were multiple projectiles. The latter cases resulted in heavier damages. Etiologically the events were classified as: 3 cases as suspected murder, 2 as attempted suicide and in the last case, an accident. The management has been both medical and surgical under general anesthesia, in order to repair the disorders and/or remove the bullets in 5 occasions. The sixth case did not allow removal of the bullet because of expected risk. All the cases did seemingly well, in spite of 2 who had postoperative complications which delayed healing.

Accidents↗

The artificial sphincter (AS-800). Experience in children and young adults.

From reviewing our experience in the application of the AS-800 sphincter for the management of incontinence in children, we conclude that implantation is indicated after conservative and less invasive therapy has been attempted. The bladder neck is the site of choice for cuff placement in children. Primary deactivation and moderate or low reservoir pressures (61 to 70 and 71 to 80 cm H2O) are indicated, especially in patients with previous bladder neck surgery or an inadvertent bladder neck injury. Excess residual urine should be evacuated by clean intermittent catheterization. The AS-800 is mechanically reliable (9 mechanical failures in 45 sphincters). When the sphincter is implanted in a select group of patients, upper tract function is maintained in a stable state. Detubularized augmentation cytoplasty must be used to supplement the sphincter in patients with low-compliance, low-capacity, and nonresponsive hyperreflexic bladders. In all patients, long and careful follow-up is necessary to identify late changes in bladder function and consequent upper tract damage. An overall satisfactory result (fair to good) was obtained in 88 per cent of patients during an average follow-up period of 35 months, and 0.6 modifying procedure per patient was done in the sphincters.

Adolescent↗

Alleged inner ear trauma: compensation pending.

The English literature on the incidence of nystagmus in normal subjects and in patients with head and/or neck injuries is reviewed. The authors present a series of 202 patients with alleged vestibular trauma. The incidence of spontaneous and positional nystagmus would seem to be no greater in patients with alleged vestibular trauma than that found in the normal subjects, suggesting that these patients do not have objective evidence of vestibular trauma. Objective criteria for diagnosing vestibular abnormalities by electronystagmography are presented. At least 22% of a series of 2408 patients were found to have a functional hearing loss. The importance of looking for functional overlay in patients involved in litigation cases is stressed.

Adolescent↗

Section II: General orthopaedics. Anterior cervical fusion for trauma.

Anterior bone grafts of 24 injured cervical spines were reviewed with respect to early postoperative instability and eventual malunion. Spinal redislocation or graft extrusion occurred in 21% representing failure to attain early stability. In 38%, the late complication of kyphotic malunion occurred, averaging 21%. The Yale instability criteria were fulfilled in 15 cases and mechanical complications developed in 87% of these. When posterior instability was present, the mechanical complication rate rose to 92%. Early stabilization of most neck injuries is not achieved by the anterior bone graft and its use as a means of "stabilization" is unsubstantiated by clinical experience.

Adolescent↗

Cervical spondylosis.

The "hard" cervical disc, a bony ridge resulting from periosteal activity, usually occurs in the patient with a previous neck injury. The "soft" disc is the bulging or extruded disc itself, often manifested by acute radicular pain in the younger patient. Causes of spondylotic myelopathy include a congenitally narrow spinal canal, disc degeneration and impaired vascularity. Disc syndromes include dysphagia and vertebral artery compression.

Angiography↗

[Hemicrania and cerebral ischemia in young adults].

A retrospective study was conducted on a young adults population affected by permanent symptoms of cerebral focal ischemia. Within 6 years, 24 patients between the ages of twenty and fifty were admitted to the Neurological and Medical department of our Hospital because of cerebral ischemic stroke. In 7 (29.2%) there was a previous history of common or classic migraine. No patients suffered headache at the time of neurologic deficit onset. In the other 17 patients in the study, 6 (25%) had valvular heart disease, 2 (8.3%) had signs suggestive of vasculitis, 2 (8.3%) had a story of head and neck injury, and in the remaining 7 (29.2%) patients no discernible etiology was demonstrated. Our data confirm the hypothesis that migraine may be considered an etiologic factor for persistent cerebral ischemia in young adults.

Adult↗