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PubMed1984

The biomechanics of spinal injuries.

This manuscript is directed to review the epidemiology of spinal trauma, the anatomy of the vertebral column, spinal ligaments, muscles, motion of the spine and spinal cord. Because little information is available on the material properties of ligaments and the components of the vertebral column, this material is also included. A review of the experimental spinal cord injury models is given because of the concerted interest in this area today. Laboratory studies conducted in animals to develop typical spinal cord injury models and the corresponding alterations in perfusion and metabolic pathways, forces, and changes in the evoked potentials are discussed. Light and electron microscopy evaluations of the spinal cord are also treated. Clinical classifications of spinal injuries, pathology, and typical examples of upper cervical injuries, atlanto-axial disc locations and fractures, lower cervical spine injuries, injuries to thoracolumbar column with mathematical models, and typical force levels are given. The final section, investigation examples, provides a review of typical spinal injuries associated with sports injuries, motorcycle helmets, industrial helmets, and swimming pools investigated in our laboratories and by those of others. With lumped parameter mathematical model which predicts cervical compression, force, the various energies encountered in a one-dimensional impact is given. Typical examples of studies conducted on football helmets, motorcycle helmets, and industrial helmets are also included. Because of the importance of crash dummies used in the analysis of spinal injuries, a separate appendix is included, as well as an appendix reviewing motorcycle standards which are often dispersed throughout the literature. Considerable emphasis is placed upon actual experimental values of force and energy measured in the living animal and the most recent studies conducted in the fresh human cadaver to delineate the biomechanical mechanisms of spinal injury.

Accidents, Traffic↗
PubMed1980

[Comparative in vitro activity of chlorine and bromine on the cysts of free-living amoebae].

A continuous flow type apparatus is used for investigation of the chlorine and bromide activity in vitro on the cysts of two free-living amoeba strains : Naegleria gruberi and Acanthamoeba polyphaga. The Naegleria cysts are sensitive more to chlorine than to bromine ; those of Acanthamoeba are perfectly resistant to these disinfectants in the limit of the available concentrations in swimming-pools. The sensibility to these disinfectants stays the same at 25 degrees C and 35 degrees C.

Amoeba↗
PubMed1983

[Infection with Mycobacterium marinum from an aquarium].

Clinical, histological and electron microscopical findings of swimming pool granuloma in a 19-year-old soldier are demonstrated. Isolation of Mycobacterium marinum and positive tests with the "Marinum Sensitin" confirmed diagnosis. Problems of treatment are discussed.

Adolescent↗
PubMed1981

[Hygienic and microbiological influences exerted on natural water biotopes by algae and the growth of water plants. 1. Communication: antibacterial properties of three water algae (Hydrodictyon reticulatum, Chlorella vulgaris, Aphanothece nidulans) in vitro (author's transl)].

The growth-inhibiting behaviour of abacterial, liquid pure cultures made up of three water algae (Hydrodictyon reticulatum, Chlorella vulgaris, Aphanothece nidulans) which were made to grow profusely in special culture containers under constant exposure to light and ventilation was examined in ten different species of microorganisms during a period of contact of 4 days both in the light and in the dark. Subjected to the test were the 5 pathogenic species Staphylococcus aureus, Klebsiella aerogenes, Pseudomonas aeruginosa, Salmonella typhimurium and Candida albicans as well the 5 bacterial contamination indicators E. coli (faecal indicator), Streptococcus faecalis (enterococci), Enterobacter aerogenes ("coliforms"), Staphylococcus epidermidis (dermic germ) and Bacillus subtilis ("contamination germ"). It was found that --Hydrodictyon reticulatum and Aphanothece nidulans exert a strong antibacterial effect, while Chlorella vulgaris provides no indication of a bacterial growth-inhibiting effect. --this antibiosis is linked with the assimilative activity of the algal cultures, as in the dark no antibacterial action is discernible --the "antibiotic principle" must be liable to transitory or rapid disintegration because the algal cultures are ineffective in the dark and also culture filtrates of 5-days old algal cultures exercise no growth-inhibiting effect. With respect to the sanitation of waters it is important to state that a profuse growth of algae produces a certain, but hardly reliable "biological water disinfection" and renders difficult the assessment of the quality of a water-course as a result of the elimination of the usual contamination indicators. Therefore, additional microbiological quality parameters must be used for assessment of pollution of swimming pools with strong algal growth.

Bacillus subtilis↗
PubMed1982

Chlamydial eye infection in adults.

In Western industrialized countries, conjunctivitis caused by Chlamydia trachomatis is most prevalent in adults at about the age of 20 years. In the case of classical trachoma in developing countries, the highest incidence of active disease occurs in children between 2 and 5 years of age. Inclusion conjunctivitis in adults is usually an autoinfection, resulting from a concomitant genital chlamydial infection. By contrast, in endemic trachoma the infection is spread from eye to eye. Only rarely has a nongenital transmission of inclusion conjunctivitis been inferred, among medical personnel and after swimming-pool bathing. Neonates with inclusion blennorrhea also may transmit the infection to family members. Diagnosis relies on the demonstration of C. trachomatis recovered from infected eyes. Treating chlamydial eye infection in adults means controlling the concomitant genital infection as well. The recommended treatment is oral tetracycline or erythromycin.

Adolescent↗
PubMed1995

[A 2-month period of physical training in insulin-dependent diabetics].

Twenty type 1 diabetics participated after previous individual instructions in a 8-week physical training programme. The latter comprised three training units per week. One training unit started by 10-minute warming up exercise, then the patients pedalled on a bicycle ergometer 2 x 10 minutes with a 5-minute break with a load amounting to 80% of the oxygen consumption during the maximum tolerated load. The final part was formed by swimming in a swimming pool, covering a distance of at least 200 m. After the termination of the programme the authors did not observe significant changes in the carbohydrate and lipid metabolism nor in physical performance, however, the maximal oxygen consumption increased as a result of training by 17% and the maximum achieved load by 25 W (i.e. one step). Throughout the investigation period the authors did not record any serious complications. The patients enjoyed the physical activity and reported improvement of the quality of life. Therefore the authors recommend physical training in the treatment of insulin-dependent diabetic patients.

Adult↗
PubMed1995

Near-drowning.

Near-drowning and drowning are major causes of neurologic injury and death in young persons. Most victims aspirate water, and pulmonary edema develops in many of these cases. Prolonged submersion causes cerebral asphyxia and adversely affects the brain within five minutes. Immediate ventilation and oxygenation are essential in the reversal of cerebral anoxia. During field resuscitation, precautions should be taken to protect the cervical spine because of the possibility of injury. The Heimlich maneuver is used only after unsuccessful attempts at ventilation suggest foreign-body obstruction. Prehospital advanced cardiac life support with tracheal intubation is indicated in patients with severe injuries. On arrival at the hospital, ventilation with continuous positive airway pressure or positive end-expiratory pressure enhances pulmonary function. Many water submersion accidents are avoidable; close supervision of infants and toddlers, installation of a fence around home swimming pools, and abstinence from alcohol during participation in water sports are some practical precautions.

Cardiopulmonary Resuscitation↗
PubMed1995

Cryptosporidia--who is at risk?

Cryptosporidium parvum is a coccidian parasite originally described a century ago and, until recently, not considered to be a human pathogen. It has a complex life cycle, including both sexual and asexual reproduction, an auto-infectious cycle, and the ability to complete its development within a single host. The transmission form is a robust, environmentally resistant oocyst, excreted in the stool, which can exist for long periods of time in the environment. Because animals, in particular domesticated livestock, are its primary host, human infection is usually zoonotic. Oocysts often find their way into water supplies, and it resists chlorination and is incompletely filtered from processed drinking water supplies, even when filtration is working optimally. Transmission via ingestion of fecally contaminated swimming pool water, food, fomites, and sexual activities facilitating fecal-oral inoculation have been demonstrated. The major target of C. parvum in the host is the intestinal epithelial cell, resulting in diarrhea, sometimes profuse and persistent, although it may also infect other organs such as the gall bladder and lungs. Pathogenesis involves attachment, probably via a sporozoite lectin, invasion, probably involving apical organelles, replication within a parasitophorous vacuole with the host cell membrane, causing cellular dysfunction. Diagnosis is generally made by visualization of the oocyst form in stool by staining methods, the best of which appears to be auramine and fluorescence microscopy. Those at greatest risk are immunocompromised adults and children, especially those with AIDS, children in day care, travelers to endemic regions, dairy or cattle farm workers of their families or contacts, household contacts of cases or carriers, and possibly owners of infected dogs or cats or their neighbors. There is no specific therapy available, however in the immunocompetent host the illness is self-limited, lasting from a few days to 3 weeks, and long term carriage is uncommon. In the immunocompromised host, infection is prolonged, sometimes asymptomatic, but may result in chronic debilitating diarrhea with dehydration, malabsorption and wasting. Public health measures to reduce contamination of water supplies and vigilant surveillance will reduce the risk to populations. Reducing behaviors favoring fecal-oral transmission, such as certain sexual activities, and scrupulous hygiene in the day care setting would also reduce the likelihood of transmission but not eliminate it. Given our lack of knowledge about Cryptosporidium biology and pathogenesis, high priority should be given to research designed to increase our understanding of the organism and improve the chance of developing useful therapeutic or preventative drugs or strategies.

Adult↗
PubMed1995

Rehabilitation of low back pain patients. A review.

Numerous methods have been developed for the rehabilitation of low back pain patients, including spinal flexion and extension exercises, lumbar spine locking in an intermediate position, enhancement of spinal and pelvic proprioceptive sensibility, swimming pool therapy, back schools, and functional restoration. Each seeks to achieve a goal assumed to be central to the prevention of a first or recurrent episode of low back pain. Goals include short-term pain relief, an improved ability to achieve self-sedation, abdominal and lumbar muscle strengthening, increased hip and lumbar spine mobility, improved lumbar and pelvic proprioceptive sensibility, intervertebral joint stabilization, lumbar posture modification and improved general fitness. Less than 30 studies meeting widely accepted validity and applicability criteria for therapeutic trials have addressed the clinical efficacy of rehabilitation in low back pain patients. Most studies of the back school approach have found no benefit. Spinal flexion and extension exercise programs have yielded short-lived improvements, with no differences across methods. There is evidence that functional restoration programs based on graded activity may provide long-term benefits including better social and occupational outcomes. We have evaluated the physical therapy methods most commonly taught to and used by physical therapists in France.

Back Pain↗
PubMed1994

Isolation and identification of free-living amoebae from some water sources in Alexandria.

Samples from different water sources of Alexandria, and from nasal passages of 500 healthy children inhabiting areas nearby these sources were examined for the presence of free-living amoebae. These samples were cultured on 1.5% non nutrient agar streaked with bacteria. Amoebae were isolated and identified by means of their morphological characters and ability to produce flagellated forms. Characteristics of the cystic stages and pattern of excystation also aided in the identification of the various species. Nine species, Naegleria gruberi, N. fowleri, Acanthamoeba rhysodes, A. glebae, A. culbertsoni, A. astronyxis, A. palestinensis, V. avara and V. inornata were isolated from the water of canals and drains. N. gruberi and A. rhysodes were found in the nasal passages of six healthy children living near the contaminated canals. No amoebae were encountered in the drinking water, swimming pools, sea and lake water included in this study.

Acanthamoeba↗
PubMed1994

Diving injuries: a preventable catastrophe.

During a 5-year period from January 1987 through January 1992, 58 patients were admitted to the Allegheny General Hospital trauma center for non-scuba, non-suicidal diving injuries. There were 46 men and 12 women (mean age, 23 years). Forty-five patients were injured in swimming pools. Twenty-two patients had blood alcohol levels > 100 mg/dL. Cervical spine injury was the most common pathologic entity encountered in this group of patients. Closed head injury, pelvic fracture, thoracic vertebral fracture, and rib fractures were other injuries identified. Some patients had multiple organ failure syndrome. Aquatic recreational activities carry a risk for injury that is preventable. The mechanism, clinical data, and complications of 58 patients are presented and the importance of prevention is discussed.

Adolescent↗
PubMedDate not supplied

Risk factors for drowning and near-drowning among children in Hillsborough County, Florida.

The authors obtained data from 700 households in Hillsborough County, FL, in a telephone random survey to determine risk factors for incidents of drowning and near-drowning among children in the county. The survey was conducted from August through December 1991. A combination of forced-choice and open-ended questions was used to assess adults' drowning-related knowledge, attitudes, and prevention behaviors, as well as the incidence of and the circumstances surrounding drowning and near-drowning among children who lived in those households. The results showed that although most respondents had some knowledge of the epidemiology of drowning and near-drowning among children, deficits were noted in their knowledge of the importance of adult supervision and the recommended age at which to begin children's swimming instruction. Results showed a need for isolation fencing, that which separates a swimming pool from a house and yard. Most respondents reported that they did not know how to perform cardiopulmonary resuscitation (CPR) on an infant or child. More than 40 percent reported not knowing how to perform CPR on an adult. Respondents reported no drowning or near-drowning incidents among children of their household within the last 3 years. However, the respondents did describe water-related immersions that involved children who experienced difficulty in the water, but recovered by themselves or with the aid of a nearby person. In some instances the child's breathing pattern was altered. There were three episodes during which difficulty in breathing occurred. The respondents reported a total of nine childhood water-immersion episodes within their families, none of which had been reported to treatment facilities. Recommendations are provided for programs for prevention of childhood drowning.

Adolescent↗
PubMed1995

[Epidemiology of microbial resistance to biocides].

In order to estimate the distribution of bacteria and fungi with an elevated level of resistance to antimicrobial substances, we have analyzed water samples and surveyed institutions presumably concerned with analyses of microbial resistance (university institutes for hygiene, health authorities) by means of questionnaire. A total of 41 water samples was drawn from various aquatic biotopes in the region of Heidelberg. The samples originated from the effluents of a community sewage treatment plant, from the Neckar river, from drinking water supplies and from public swimming pools. The following substance groups were included in a search for bacteria with an elevated resistance to antiseptics and disinfectants: Aldehydes, biguanides, quaternary ammonium compounds (QAC), phenols and halogen. Upon determination of the maximal tolerated concentrations to these antimicrobial agents, samples of treated wastewater effluents showed a considerably higher prevalence of bacteria resistant to formaldehyde, chlorhexidine and QAC. The highest levels of resistance were found in Pseudomonas aeruginosa, Pseudomonas putida, Pseudomonas fluorescens and Enterobacter species. The maximal tolerated level of 0.06 percent formaldehyde by weight was considerably higher than the levels tolerated by the corresponding ATCC reference strains. The highest levels of resistance to a biguanid/QAC preparation were seen in isolates of Alcaligenes species and Providencia species, with a maximal tolerated level of 0.5 volume percent. In addition, several isolates of E. coli and Klebsiella species were observed which showed a considerably higher level of resistance to the biguanide preparation as compared to the corresponding ATCC reference strains. A questionnaire was mailed to a series of institutions and companies presumably concerned with problems of microbial resistance. Responses were in accordance with our own observations, both with regard to the spectrum of bacteria observed and to the antimicrobial substances concerned.

Aldehydes↗
PubMed1995

[In vitro sensitivity of Mycobacterium chelonae strains to various antimicrobial agents].

The in vitro susceptibility of 32 Mycobacterium chelonae strains to 10 antimicrobial agents was determined. The sources of the different strains were: clinical samples from patients treated at the Hospital Universitario de Canarias and Hospital del Tórax (General and Chest facilities) and from environmental sources (water supply, sewage, swimming pools and the sea). The susceptibility tests were performed by a broth microdilution method (Mueller-Hinton Broth). The results showed amikacin as the most effective antimicrobial agent against M. chelonae isolates, then ofloxacin and cefoxitin. However no statistical difference was detected among them. The least effective was imipenem, followed by ciprofloxacin and norfloxacin.

Amikacin↗
PubMed1996

[Results of kinesis therapy in patients with diabetic macroangiopathy of the lower extremities].

In 30 patients with diabetes type II and macroangiopathy of lower extremities, physical training was applied. This treatment was carried on in our Clinic for average 4 weeks. The following methods were applied: individual exercises of legs once or twice daily for 30-minutes, training in brine swimming pool for 30 minutes every-day, treatment walks with proportioning effort. Value of physical effort was not more than 30-40% max. pulse rate. The examination was performed before and after the programme of treatment. The examination included the following parameters: subjective test on cycloergometer, examination of blood flow velocity by Doppler method and biochemical examination of glycaemia and lipidemia. We found improvement in intermittent claudication distance, significant subjective improvement in velocity of blood flow in lower extremities. In our opinion physical vascular training is a valuable method of mono-operative treatment of vascular disease of legs in diabetic patients.

Adult↗
PubMed1996

[Pseudomonas aeruginosa folliculitis after depilation].

INTRODUCTION: Pseudomonas aeruginosa is usually the responsible agent for epidemics of folliculitis acquired in swimming pools and whirlpools. Sporadic cases of Pseudomonas folliculitis after epilation of the legs are well known by dermatologists, but unfrequently reported in the literature. CASE REPORT: We report the case of a 18-year-old female affected of folliculitis of the legs caused by Pseudomonas aeruginosa, after depilation. A meticulous investigation of contaminant sources was performed, and the responsible was the sponge used to wash the legs after depilation. DISCUSSION: Pseudomonas aeruginosa folliculitis after depilation is more frequent than usually reported. A meticulous study of the concomitant source of contamination is essential to avoid recurrent episodes.

Administration, Topical↗
PubMed1997

[Mycobacterium marinum. A rare cause of infection of the skin and joints].

Mycobacterium marinum is a rare cause of disseminated infection in man. The case report describes an 80-year-old woman, who had been treated with oral corticosteroids for bronchial asthma for 40 years, and in the same period had been swimming daily in swimming pools. At the first admission, the symptoms and clinical findings were interpreted as seronegative rheumatoid arthritis. After eight years of disease with recurrent infections of the skin, periarticular tissues and joints in the hands and one elbow, a biopsy specimen from an abscess showed granulomatous inflammation and acid fast bacilli. Culture for mycobacteria grew M. marinum. There was a severe, destructive monoarthritis in the right second metacarpophalangeal joint. The patient recovered completely on treatment with clarithromycin and doxycycline.

Aged↗