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PubMed1994

Incidental finding of occult hydronephrosis after blunt abdominal trauma.

Occult congenital and acquired renal lesions are often discovered during evaluation of patients with haematuria after minor blunt torso trauma. This relatively 'minor trauma', can precipitate severe haematuria and hypovolemic shock. This group of patients frequently presents a difficult diagnostic and therapeutic challenge. We discuss the significance of occult hydronephrosis and minor blunt trauma in one patient.

Abdominal Injuries↗
PubMed1990

A muscular endurance training program for symmetrical and asymmetrical manual lifting tasks.

The purpose of this study was to test whether the endurance limits of new employees engaged in symmetrical and asymmetrical manual lifting tasks can be significantly increased through a physical training program. Each subject participating in the training program performed a total of 16 sessions. A control group performed two sessions separated by a 4-week interval. The results of this study showed that endurance time increased by 248% for the symmetrical and 46% for the asymmetrical lifting tasks. Furthermore, the frequency of handling increased by 44% and 34% for these tasks, respectively. The control group showed no improvement in terms of endurance time and frequency of handling. The implementation of a physical training program as a tool to control overexertion injuries in industrial settings is outlined.

Accidents, Occupational↗
PubMed2002

Low back pain in the adolescent athlete.

There are several other entities such as infection, tumors, and fractures that I have not covered in this article. These entities are not common in adolescent athletes but must always be considered when athletes do no respond to typical treatment protocols for the problems I have discussed. The most important theme to take from this article is that low back pain in adolescent athletes is a problem that should not be ignored but instead fully evaluated because structural problems are quite common in this patient population.

Adolescent↗
PubMed2005

Evaluation of an intervention comprising a no lifting policy in Australian hospitals.

The No Lifting Policy has been adopted in Australia to prevent back pain and injuries among nurses. The present study focuses on the intervention of the "No Lift System" (NLS). The purpose of this cross-sectional study was to evaluate the use of transfer equipment, number of injuries, pain/symptoms and absence from work among nurses after the intervention of the NLS (n=201), and compare to nurses at two control hospitals (n=256). A comprehensive questionnaire was used for data collection. The results show that at the hospital where the NLS had been introduced, the nurses used the purchased transfer equipment regularly. They had significantly fewer back injuries, less pain/symptoms and less absence from work due to musculoskeletal pain/symptoms compared with nurses at the control hospitals. The study showed strong evidence for supporting the implementation of the NLS. The positive results shown in the present study can probably be explained by the agreement between the management, the union and the nurses concerning the implementation of the NLS, as well as its comprehensive approach and participatory design.

Adult↗
PubMed1996

Mechanical stability of the in vivo lumbar spine: implications for injury and chronic low back pain.

One important mechanical function of the lumbar spine is to support the upper body by transmitting compressive and shearing forces to the lower body during the performance of everyday activities. To enable the successful transmission of these forces, mechanical stability of the spinal system must be assured. The purpose of this study was to develop a method and to quantify the mechanical stability of the lumbar spine in vivo during various three-dimensional dynamic tasks. A lumbar spine model, one that is sensitive to the various ways that individuals utilize their muscles and ligaments, was used to estimate the lumbar spine stability index three times per second throughout the duration of each trial. Anatomically, this model included a rigid pelvis, ribcage, five vertebrae, 90 muscle fascicles and lumped parameter discs, ligaments and facets. The method consisted of three sub-models: a cross-bridge bond distribution-moment muscle model for estimating muscle force and stiffness from the electromyogram, a rigid link segment body model for estimating external forces and moments acting on the lumbar vertebrae, and an 18 degrees of freedom lumbar spine model for estimating moments produced by 90 muscle fascicles and lumped passive tissues. Individual muscle forces and their associated stiffness estimated from the EMG-assisted optimization algorithm, along with external forces were used for calculating the relative stability index of the lumbar spine for three subjects. It appears that there is an ample stability safety margin during tasks that demand a high muscular effort. However, lighter tasks present a potential hazard of spine buckling, especially if some reduction in passive joint stiffness is present. Several hypotheses on the mechanism of injury associated with low loads and aetiology of chronic back pain are presented in the context of lumbar spine stability.

Journal Article↗
PubMed1997

Diagnosis of injuries after stab wounds to the back and flank.

BACKGROUND: Historically, patients with deep posterior wounds underwent a formal celiotomy to rule out injury. Currently, we use a policy of selective management. The purpose of this review is to evaluate our experience with selective management to identify potential areas of further improvement. METHODS AND RESULTS: This study includes 203 patients over a 10-year period. By changing from a policy of mandatory exploration to selective management the total celiotomy rate decreased from 100 to 24% and the therapeutic celiotomy rate increased from 15 to 80%. CONCLUSIONS: In stable patients, a diagnostic peritoneal lavage should be performed as the initial diagnostic study. When diagnostic peritoneal lavage is negative, triple contrast computed tomography should be performed to evaluate the remaining retroperitoneal structures. Any suggestion of pericolonic extravasation of contrast or air, edema, or hemorrhage must be interpreted as a positive study and prompt consideration for operative exploration.

Abdominal Injuries↗
PubMed1990

Threshold of carotid artery back pressure for delayed neuronal injury in the hippocampus after bilateral common carotid artery occlusion in gerbils.

The threshold of carotid artery back pressure for the development of neuronal injury in the hippocampus was determined in gerbils following bilateral carotid artery occlusion of 5 or 10 min. Arterial back pressure was measured during ischemia at the left carotid bifurcation distal to the vascular occlusion, and neuronal injury evaluated one week after ischemia by counting the number of surviving neurons in the left hippocampal CA1 sector. With an arterial back pressure below 5 mm Hg, the mean density of surviving neurons decreased from 199 +/- 16/mm (mean +/- SD) to less than 21/mm both after 5 and 10 min ischemia (P less than 0.05). With a back pressure of between 5 and 15 mm Hg, neuronal density was 117 +/- 77/mm (not significantly different from control) after 5 min, and 24 +/- 18/mm (P less than 0.05) after 10 min ischemia. Above 15 mm Hg neither 5 nor 10 min ischemia produced significant neuronal damage. Thus, at threshold arterial back pressure, induction of neuronal injury in the hippocampus depends on the duration of ischemia, indicating progressive impairment of microcirculation with longer periods of ischemia.

Animals↗
PubMed2005

Epidemiology of injuries in English professional rugby union: part 1 match injuries.

OBJECTIVES: To undertake a detailed, large scale epidemiological study of match injuries sustained by professional rugby union players in order to define their incidence, nature, severity, and causes. METHODS: A two season prospective design was used to study match injuries associated with 546 rugby union players at 12 English Premiership clubs. Team clinicians reported all match injuries on a weekly basis and provided details of the location, diagnosis, severity, and mechanism of each injury. Match exposures for individual players were recorded on a weekly basis. Loss of time from training and match play was used as the definition of an injury. RESULTS: The overall incidence of injury was 91 injuries/1000 player-hours, and each injury resulted on average in 18 days lost time. Recurrences, which accounted for 18% of injuries, were significantly more severe (27 days) than new injuries (16 days). Thigh haematomas were the most common injury for forwards and backs, but anterior cruciate ligament injuries for forwards and hamstring injuries for backs caused the greatest number of days absence. Contact mechanisms accounted for 72% of injuries, but foul play was only implicated in 6% of injuries. The ruck and maul elements of the game caused most injuries to forwards, and being tackled caused most injuries to backs. The hooker and outside centre were the playing positions at greatest risk of injury. CONCLUSIONS: On average, a club will have 18% of their players unavailable for selection as a consequence of match injuries.

Adult↗
PubMed1999

Measures to prevent cricket injuries: an overview.

Cricket is a major international sport, generally played in British Common-wealth nations. Although strictly a non-contact sport, injuries in cricket can result in a number of ways. In high level cricket, overuse injuries are common and related to the physical demands of the sport, particularly in the delivery of the ball. The bowling action involves repetitive twisting, extension and rotation of the trunk at the same time as absorption of large ground reaction forces over a short period of time. These movements, if performed incorrectly or too frequently, can lead to overuse injuries of the back, particularly in elite and high level cricketers. Cross-sectional studies have demonstrated that spinal overuse injuries occur more frequently to cricketers adopting a mixed bowling action than to those who favour a front- or side-on bowling technique. Strategies to ensure that cricketers do not adopt the mixed action or bowl too fast for extended periods can prevent these back injuries. Injuries resulting from impacts, generally from the cricket ball, can also occur and are more common during low level competition or informal participation. Because of the potential severity of these impacts, a range of protective equipment ranging from body padding to gloves and face protectors are now common features of standard cricket equipment. Although a number of measures to prevent cricket injuries have been widely suggested in the literature, there have been very few studies that have formally assessed their effectiveness in preventing injury. Further research is needed to gain a greater understanding of the biomechanics of cricket actions, the mechanisms of resultant injuries and the role of various risk factors in injury causation.

Adolescent↗
PubMed1996

Low-back pain in adolescent athletes.

In this 3-yr longitudinal study we investigated the occurrence of low-back pain and anatomic changes in the low back in relation to loading and injuries among 98 adolescents: 33 nonathletes (16 boys, 17 girls), 34 boy athletes (17 ice hockey, 17 soccer players), and 31 girl athletes (17 figure skaters, 14 gymnasts). During the 3-yr follow-up, low-back pain lasting longer than 1 wk was reported by 29 (45%; 95% CI, 32%-57%) athletes and by 6 (18%; 95% CI, 7%-35%) nonathletes (P = 0.0099). Acute back injury was reported by 17 of 19 subjects who also reported low-back pain (89%; 95% CI, 67%-99%) and by 2 of 63 of those without prolonged low-back pain (3%; 95% CI, 0%-11%) (P < 0.0001). Among 43 girls participating in baseline and follow-up MRI examinations of the lumbar spine, new MRI abnormalities were found in 6 of 8 reporting acute back injury (75%; 95% CI, 35%-97%) and in 8 of the remaining 35 girls (23%; 95% CI 10% to 40%) (P = 0.018). In conclusion, excessive loading that involves a risk for acute low-back injuries during the growth spurt is harmful to the lower back.

Adolescent↗
PubMed1993

Recovery from low back pain. 1-5 year follow-up of 287 injury-related cases.

This study investigated the factors affecting recovery from low back injury. The study population was designed to be representative of patients presenting with back pain following soft tissue injury. A minimum follow up rate of 90 percent was achieved with a length of elapsed time from the injury of up to five years. Three established methods of assessment of disability and functional capacity (The Oswestry disability scale, The Waddell disability scale and The Waddell physical impairment rating) were compared to each other and a new scale (The Low-Back Outcome Scale) for the measurement of a patient's performance in employment, social activities and activities of daily living. The relationships of these scales to employment, psychological disturbance and other factors were defined. The Outcome Score designed for use in this study provided a comprehensive and discriminating assessment of patient function. Compensation (particularly lump sum claims), psychological disturbance at review, time off work, and age at injury were important factors in recovery; the diagnosis, type and severity of injury, migrant status and neurological deficits were not. Eight psychometric instruments were examined, and the combination of The Zung Depression Scale and The Modified Somatic Perception Questionnaire was found to be the most accurate in determining the presence of psychological disturbance in patients with low back pain.

Activities of Daily Living↗
PubMed1997

How does Helicobacter pylori cause mucosal damage? Direct mechanisms.

Helicobacter pylori-associated gastritis is characterized by an abundant inflammatory response and gastric epithelial cell injury. Adherence of H. pylori to gastric epithelial cells seems to be required for bacterial colonization of the gastric mucosa. Attachment of the bacterium to polarized gastric epithelial cells causes damage to microvilli and stimulates actin polymerization, which is associated with adherence pedestal formation. Studies suggest that H. pylori directly contributes to the injury of gastric epithelial cells by the elaboration of cytotoxic factors. The first toxin identified from H. pylori strains, known as vacuolating cytotoxin, induces vacuole formation in eukaryotic cells. Elaborated enzymes by H. pylori may also contribute directly to epithelial cell injury. Ammonia produced through urease activity may be toxic to gastric epithelial cells. H. pylori protease and lipase degrade gastric mucus and disrupt the phospholipid-rich layer at the apical epithelial cell surface, allowing for cell injury from back diffusion of gastric acid. This cell injury may lead to cell death, believed to result from induction of apoptosis. There are sufficient data to suggest that H. pylori, through direct pathogenic mechanisms, contributes significantly to the gastric mucosal injury associated with this infection, and may enhance the susceptibility of gastric epithelial cells to carcinogenic conversion.

Bacterial Adhesion↗
PubMed2003

Blunt trauma soft-tissue uptake on skeletal scintigraphy.

Muscle and soft-tissue uptake have been described numerous times in the literature in patients undergoing Tc-99m methylene diphosphonate skeletal scintigraphy following trauma. Many of these traumas range from electrical burns, intramuscular injections, sports-related trauma, and overexercising, to actual physical damage resulting in superficial bruising and skin discoloration. In this case the patient presented with continuing low back pain after falling down some stairs. Although the scan was essentially normal for bony trauma, subtle soft-tissue uptake was detected that was enhanced with the addition of single photon emission computed tomographic imaging and surface rendering.

Accidental Falls↗
PubMed1997

Why don't more Israelis wear seat belts in the back seat?--a possible explanation.

BACKGROUND: Most Israelis wear seat belts in the front seat of automobiles; most do not wear them in the back. A possible explanation is considered, that Israelis believe seat belts to be less necessary in the back, and that this is related to the relative discrepancy in seat belt use. METHOD: A telephone survey of 1148 Israeli adults was conducted in September 1996, using random-digit dialing. RESULTS: On a six-point scale of perceived risk, respondents rated seat belts as more necessary for passengers in the front than in the back seat [D = 0.6, SD = 1.0, t (873) = 18.3; p < .001]. Moreover, respondents' self-reported use of seat belts in the back seat (35% overall) was significantly higher among respondents who believed seat belts in the back to be necessary [46%; chi 2 (N = 882, df = 2) = 20.6; p < .001)], yet was not significantly higher among respondents who believed wearing seat belts in the front to be necessary [38%; chi 2 (N = 903, df = 2) = 3.8; p > .05)]. Respondents' reports of buckling their children in the back seat (55% overall) were significantly higher among respondents who believed seat belts in the back to be necessary [62%; chi 2 (N = 309, df = 2) = 7.0; p < .05)], yet were not significantly higher among respondents who believed wearing seat belts in the front to be necessary [57%; chi 2 (N = 313, df = 2) = 0.9; p > .05)]. CONCLUSIONS: The results suggest that a potentially effective strategy in Israel for promoting the use of seat belts in the back seat of automobiles should include convincing the public of the necessity of wearing seat belts in the back, by increasing the perceived risk of injury to back seat passengers.

Accidents, Traffic↗
PubMed1996

Role of adenosine and nitric oxide in the hyperemic response to superficial and deep gastric mucosal injury and H+ back-diffusion in cats.

BACKGROUND: This study was undertaken to examine the role of adenosine and nitric oxide (NO) in the hyperemic response to H+ back-diffusion into superficially or deeply injured gastric mucosa, and the role of adenosine in mucosa when blood flow was reduced with indomethacin. METHODS: Cat stomachs were exposed to 2 M NaCl for 10 min followed by luminal perfusion at pH 1. Gastric mucosal blood flow was determined by radioactive microspheres, portal vein blood flow by transit-time flowmetry, and H+ back-diffusion/secretion by pH-stat titration, and concentrations of histamine in aortic and portal vein blood were measured. RESULTS: In the antrum pretreatment with the adenosine blocker 8-phenyltheophylline (8-PT) or with NG-methyl-L-arginine (L-NMMA), a specific inhibitor of NO formation, had no effect on the hyperemic response or mucosal injury. However, pretreatment with 8-PT in addition to indomethacin produced extensive deep lesions in the antrum. In the corpus/fundus 8-PT had no effect on the hyperemic response and did not increase indomethacin-induced lesions. L-NMMA significantly reduced the hyperemic response in corpus/fundus. In areas with deep lesions very high blood flow was observed in the vital part of the mucosa below the necrotic tissue. This hyperemia was reduced by L-NMMA but not by 8-PT. Indomethacin increased the release of histamine during base-line conditions, whereas 8-PT reduced histamine release after damage. CONCLUSIONS: This study indicates that usually adenosine is not involved in the hyperemic response to mucosal damage, but it appears to have important protective functions in the antral mucosa under marginal circulatory conditions. NO is one of the mediators of the hyperemic response to mucosal injury in the corpus/fundus.

Adenosine↗