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Onchocerca-like lesions induced by the filarioid nematode Cercopithifilaria johnstoni, in its natural hosts and in the laboratory rat.

Histo-pathological analysis of the eyes, ears, skin and associated skeletal muscles of the back of 14 animals infected with a filarioid worm with dermal microfilariae, Cercopithifilaria johnstoni: seven Rattus fuscipes, of which four were naturally infected, two marsupials, Perameles nasuta and Isodon macrourus, and five R. norvegicus. This filarioid nematode induces skin and eye lesions in all the infected animals. These lesions are similar to those described earlier with other filarioid species with dermal microfilariae, such as Monanema martini and Onchocerca volvulus; the pathogeny is similar: microfilariae live inside the lymphatic vessels and their accidental exit gives rise to a localized inflammatory reaction leading to fibrosis. C. johnstoni is particularly interesting because it may be adapted to the laboratory rat, and because the ocular lesions are severe.

Animals↗

Tragic case of a dog bite in a young child: the dog stands trial.

The authors present the tragic case of an 18-month-old child who was bitten by a dog, causing amputation of the forearm and substantial damage to the cutaneous muscle on his back, shoulder, thorax, and neck. A free latissimus dorsi flap was performed to preserve the humerus from which the periosteum had been torn away. A series of cutaneous expansions were then undertaken to graft skin back onto the back, the armpit, and the shoulder stump, to allow for a mechanical prosthesis. A study of the literature on this subject proves that dog bites are more frequent and serious (sometimes even fatal) in young children than in adults. In view of the current legislation, it would seem that the public health authorities are doing little to resolve this distressing problem.

Amputation, Traumatic↗

Imaging radiation induced muscular necrosis with antimyosin-scintigraphy and computed tomography.

Radiations accidents involving high exposures require accurate assessment of radiation dose for correct surgical or medical management. Techniques involving computed tomography and antimyosin-antibody scintigraphy were evaluated in an experimental model of acute localized irradiation overexposure to 192Ir. Ten rabbits were exposed to a single dose of 192Ir gamma irradiation (120 Gy) on the back (right iliospinal muscle). Computed tomography and antimyosin-antibody scintigraphy results were compared with those in four control animals. Planar scintiscans (posterior views) were performed 48 h post-injection of antimyosin-antibody each week for 2 mo after exposure. An antimyosin uptake was observed in irradiated muscle five weeks after exposure and correlated with computed tomography and histopathology results, showing muscle necrosis. Biodistribution assessed at 7 and 9 wk post exposure confirmed antimyosin-antibody accumulation in damaged muscle. A semi-quantitative analysis of a region of interest over the uptake area in the irradiated muscle (on the right side) and a contralateral non-irradiated region of interest used as control showed that uptake was significantly higher in irradiated animals than in control animals (p < 0.02). Antimyosin-antibody scintiscans used in nuclear cardiology to explore ischemic heart disease, myocarditis or heart transplant rejection could be realized to assess the extent of muscle necrosis after trauma or radiation induced injury.

Animals↗

A new accurate and non-invasive screening method for renovascular hypertension: the renal artery Doppler technique.

The clinical use of ultrasonic echo Doppler velocimetry as a screening test for renal artery stenosis was investigated in 11 control subjects and 20 hypertensive patients including 10 with renovascular disease. In these hypertensive patients, the accuracy of the diagnosis of renal artery stenosis using the echo Doppler method was compared with that of angiography. The accuracy of the radionuclide renography in the same subjects was also investigated and compared with that of the echo Doppler method. Seven patients with renovascular disease who required angioplasty were examined again after the operation. The duplex Doppler signals were detected through the muscle of the back (the translumbar approach). Diagnosis of renal artery stenosis was based on three objectively defined Doppler parameters, the acceleration index, the acceleration time, and the acceleration:time ratio. In comparison with angiography, the accuracy of the echo Doppler method evaluated by using these parameters was 95%; the sensitivity was 100% and the specificity was 93%. The accuracy of the ultrasonic study was superior to that of radionuclide renography (80%). The acceleration index of the affected side was significantly correlated with the percentage stenosis of the renal artery. The changes in renal arterial blood flow following the operation were detected well by the Doppler parameters. This non-invasive method is one of the most accurate screening tests available for renovascular hypertension and has also proved quite useful for follow-up examinations in the patients with angioplasty.

Blood Flow Velocity↗

Trunk muscle myoelectric activities in idiopathic scoliosis.

Twenty adolescent girls with mild-to-moderate cases of idiopathic scoliosis and twelve adolescent girls with structurally normal spines performed 15 exercises isometrically while standing. The exercises included resisting flexion, extension, and lateral bending moments imposed on the trunk. Myoelectric activities in 12 trunk muscle groups were measured during these performances, using surface electrodes. For one set of comparisons, the patients were divided into those whose clinical records documented curve progression and those with no documented progression. No significant differences were noted in mean myoelectric activities between these two patient groups. For a second set of comparisons, the subjects were divided into patients with curves of more than 25 degrees, patients with curves of 25 or fewer degrees and normals. No significant differences in mean myoelectric activities were noted between the patients with the smaller curves, while the patients with the larger curves had significantly larger convex side myoelectric activities in their anterior, lateral and posterior muscles at lumbar levels compared to the normal girls. The findings of this study, along with biomechanical model analyses, suggest that the asymmetries in muscle actions evidenced by myoelectric measurements result from scoliosis. Scoliosis progression seems not to be caused by asymmetry in muscle contractions; rather it may be caused by a lack of adequate asymmetry.

Abdominal Muscles↗

Progressive scoliosis with vertebral rotation after lumbar intervertebral disc herniation in a 10-year-old girl.

A case report of a 10-year old girl with a herniated disc is presented. The most significant symptoms were progressive scoliosis with a flat back and paravertebral muscle spasm. An absent H reflex on the left and an increased latency of the somatosensory-evoked potentials of the left posterior tibial nerve were found. The computed tomographic scan of the lumbar spine showed a large central left-sided disc protrusion at the L5-S1 level. Our case presents the youngest patient with documented intervertebral disc herniation and the only one with severe scoliosis and vertebral rotation. The curve was not structural because it improved with surgery and an orthosis was not necessary.

Child↗

Anterior disc protrusion as a cause for abdominal symptoms in childhood discitis. A case report.

STUDY DESIGN: A case report on infectious spondylitis in a child who reported abdominal pain and whose magnetic resonance image revealed anterior herniation of disc space contents. OBJECTIVES: To correlate the direction of disc protrusion in infectious spondylitis with clinical manifestations. SUMMARY OF BACKGROUND DATA: Previous studies have correlated posterior protrusion of disc space contents in infectious spondylitis with a clinical presentation of back pain, paravertebral muscle spasm, hamstrings tightness, and radiculopathy. None has connected anterior herniation of disc phlegmon with abdominal pain. METHODS: In addition to plain radiography and bone scintigraphy, magnetic resonance imaging was used to confirm the diagnosis of infectious spondylitis in a 6-year-old child with abdominal pain. Regular review for 1 year included repeat magnetic resonance imaging at 3 months. RESULTS: Initial magnetic resonance imaging revealed characteristic changes associated with infectious spondylitis throughout the L5-S1 vertebra-disc-vertebra unit and anterior protrusion of the disc material and phlegmon. Magnetic resonance imaging at follow-up examination 3 months later demonstrated complete resolution of the disc herniation. CONCLUSION: Future magnetic resonance imaging studies should correlate direction of disc herniation with age and symptomatology to validate or improve classifications of infectious spondylitis, which presently include only the last two parameters.

Abdominal Pain↗

Musculoskeletal fitness: the keystone in overall well-being and injury prevention.

Musculoskeletal fitness is an important and inadequately appreciated component of overall health and well-being. Wellness as it applies to strength and conditioning has numerous benefits. It allows maintenance of functional independence for longer periods in older adults. It impacts the metabolic capabilities of children and adults affecting the ability to maintain an ideal body weight. It has been shown to influence the prevalence and possibly the prevention of many musculoskeletal disorders such as muscle sprains, low back pain, osteoarthritis, osteoporosis, shoulder instability, and knee stability and pain. The current author summarizes the most recent recommendations for achievement and maintenance of musculoskeletal fitness for children and adults.

Accident Prevention↗

Metachronal coupling between spinal neuronal networks during locomotor activity in newborn rat.

In the present study, we investigate spinal cord neuronal network interactions in the neonatal rat during locomotion. The behavioural and physiological relevance of metachronally propagated locomotor activity were inferred from kinematic, anatomical and in vitro electrophysiological data. Kinematic analysis of freely behaving animals indicated that there is a rhythmic sequential change in trunk curvature during the step cycle. The motoneurons innervating back and tail muscles were identified along the spinal cord using retrograde labelling. Systematic multiple recordings from ventral roots were made to determine the precise intrinsic pattern of coordination in the isolated spinal cord. During locomotor-like activity, rhythmic ventral root motor bursts propagate caudo-rostrally in the sacral and the thoracic spinal cord regions. Plotting the latency as a function of the cycle period revealed that the system adapts the intersegmental latency to the ongoing motor period in order to maintain a constant phase relationship along the spinal axis. The thoracic, lumbar and sacral regions were capable of generating right and left alternating motor bursts when isolated. Longitudinal sections of the spinal cord revealed that both the bilateral antiphase pattern observed for the sacral region with respect to the lumbar segment 2 as well as the intersegmental phase lag were due to cross-cord connections. Together, these results provide physiological evidence that the dynamic changes observed in trunk bending during locomotion are determined by the intrinsic organization of spinal cord networks and their longitudinal and transverse interactions. Similarities between this organization, and that of locomotor pattern generation in more primitive vertebrates, suggest that the circuits responsible for metachronal propagation of motor patterns during locomotion are highly conserved.

Algorithms↗

Non-invasive measurement of biomechanical skin properties in systemic sclerosis.

OBJECTIVE: To evaluate biomechanical properties of skin in patients with systemic sclerosis (SSc) using the BTC-2000 suction device. METHODS: Twenty five patients with limited cutaneous SSc (lcSSc), 20 patients with diffuse disease (dcSSc), and 25 age matched healthy controls were evaluated. Viscoelastic deformation (VED, mm), elastic deformation (ED, mm), ultimate deformation (UD, mm), and pressure-deformation ratio (PDR, mm Hg/mm) were measured on the dorsal surface of the forearm, shoulder, and above the trapezius muscle on the back. RESULTS: Indices of skin extensibility (VED, ED, UD) were reduced and resistance to stress (PDR) increased in patients with dcSSc compared with healthy controls, or patients with lcSSc, at all three sites (p<0.001). At all sites, and overall, UD, ED, and VED were lower and PDR was higher at skin score above grade 2, compared with clinically normal skin. For both lcSSc and dcSSc biomechanical differences from controls were found even at sites of clinically normal skin. CONCLUSION: BTC-2000 is a sensitive tool for clinical evaluation of skin involvement in SSc and may be a valuable adjunct to skin sclerosis score in disease monitoring.

Adult↗

Kidney damage by ionizing radiation.

The report describes a case of radiation damage to a kidney due to radiotherapy of a sarcoma of the muscles of the back. The characteristic clinical, pathological and histological findings and the results of X-ray investigation are presented in detail.

Chronic Disease↗

Amyotrophic lateral sclerosis in a battery-factory worker exposed to cadmium.

A 44-year-old patient died from amyotrophic lateral sclerosis (ALS) after nine years of heavy exposure to cadmium (Cd) in a nickel cadmium (Ni-Cd) battery factory. Two years after starting work he and co-workers had experienced pruritus, loss of smell, nasal congestion, nosebleeds, cough, shortness of breath, severe headaches, bone pain, and proteinuria. Upper back pain and muscle weakness progressed to flaccid paralysis. EMG findings were consistent with motor neuron disease. Cd impairs the blood-brain barrier, reduces levels of brain copper-zinc (Cu-Zn) superoxide dismutase (SOD), and enhances excitoxicity of glutamate via up-regulation of glutamate dehydrogenase and down-regulation of glutamate uptake in glial cells. High levels of methallothionein, a sign of exposure to heavy metals, have been found in brain tissue of deceased ALS patients. The effects of Cd on enzyme systems that mediate neurotoxicity and motor neuron disease suggest a cause effect relationship between Cd and ALS in this worker.

Adult↗

Pain in veterans of the Gulf War of 1991: a systematic review.

BACKGROUND: Veterans of the Persian Gulf War of 1991 have reported a range of adverse health symptoms. This systematic review aims to identify all studies that have compared the prevalence of symptoms of pain in veterans of the Gulf War to that in a non-Gulf military comparison group, and to determine whether Gulf War veterans are at increased risk of reporting pain. METHODS: Studies published between January 1990 and May 2004 were identified by searching a large number of electronic databases. Reference lists and websites were also searched and key researchers were contacted. Studies were included if they reported the prevalence of any symptom or condition that included the word "pain" in Gulf War veterans and in a comparison group of non-Gulf veterans. 2401 abstracts were independently reviewed by two authors. RESULTS: Twenty studies fulfilled the inclusion criteria. Five main sites of pain were identified (muscle, joint, chest/heart, back and abdominal pain) and separate meta-analyses were performed to summarise the results related to each site. A greater proportion of Gulf veterans reported symptoms at each site of pain when compared to a non-Gulf military group. Gulf deployment was most strongly associated with abdominal pain, with Gulf veterans being more than three times more likely to report such pain than a comparison group (OR 3.23; 95% CI 2.31-4.51). Statistical heterogeneity between study estimates was significant, probably due to variation in measured periods of prevalence and symptom measurement methods. CONCLUSION: A higher proportion of veterans of the Persian Gulf War of 1991 reported symptoms of pain than military comparison groups. This is consistent with previously demonstrated increased reporting of more general symptoms (fatigue, multiple chemical sensitivity, post traumatic stress disorder) in these veterans compared with non-Gulf military groups. However, the primary studies were heterogeneous and varied greatly in quality.

Gulf War↗

Core stability measures as risk factors for lower extremity injury in athletes.

INTRODUCTION/PURPOSE: Decreased lumbo-pelvic (or core) stability has been suggested to contribute to the etiology of lower extremity injuries, particularly in females. This prospective study compares core stability measures between genders and between athletes who reported an injury during their season versus those who did not. Finally, we looked for one or a combination of these strength measures that could be used to identify athletes at risk for lower extremity injury. METHODS: Before their season, 80 female (mean age = 19.1 +/- 1.37 yr, mean weight 65.1 +/- 10.0 kg) and 60 male (mean age = 19.0 +/- 0.90 yr, mean weight 78.8 +/- 13.3 kg) intercollegiate basketball and track athletes were studied. Hip abduction and external rotation strength, abdominal muscle function, and back extensor and quadratus lumborum endurance was tested for each athlete. RESULTS: Males produced greater hip abduction (males = 32.6 +/- 7.3%BW, females = 29.2 +/- 6.1%BW), hip external rotation (males = 21.6 +/- 4.3%BW, females = 18.4 +/- 4.1%BW), and quadratus lumborum measures (males = 84.3 +/- 32.5 s, females = 58.9 +/- 26.0 s). Athletes who did not sustain an injury were significantly stronger in hip abduction (males = 31.6 +/- 7.1%BW, females = 28.6 +/- 5.5%BW) and external rotation (males = 20.6 +/- 4.2%BW, females = 17.9 +/- 4.4%BW). Logistic regression analysis revealed that hip external rotation strength was the only useful predictor of injury status (OR = 0.86, 95% CI = 0.77, 0.097). CONCLUSION: Core stability has an important role in injury prevention. Future study may reveal that differences in postural stability partially explain the gender bias among female athletes.

Adolescent↗

Infection of intervertebral discs after operation.

Infection of the intervertebral space is a rare complication of operation on the disc (Ford and Key 1955). It occurred in five cases in a series of 650 operations for lumbar disc protrusion done by two of the authors of this paper--an incidence of 0-8%. Symptoms began between seven and twelve days after operation. After initial relief of the original sciatic pain, the patients developed severe back pain and muscle cramps in the legs. Straight-leg raising became much more limited than before operation. The erythrocyte sedimentation rate was raised in all cases. The diagnosis was confirmed by rescreening the Myodil, when an indentation was seen opposite the intervertebral space from which the disc had been excised. Early removal of infected material from the disc space resulted in complete relief of pain and cure of the infection.

Adult↗

Exogenous lipoid pneumonia due to inhalation of spray lubricant (WD-40 lung).

An elderly woman developed lipoid pneumonia due to the inhalation of mist from a spray lubricant that she was using as a liniment for sore back and neck muscles. This unusual practice is reported to be common among older people bothered by rheumatism. The potential for this complication to occur in other patients leads us to present this case report.

Aerosols↗

[Behavioral aspects of chronic pain syndromes].

The knowledge of biological pain mechanisms are not sufficient for the understanding of patients with chronic pain syndromes such as low back, cervicobrachial and muscle pain. Psychological and psychosocial aspects play important roles in the setting and perpetuation of symptoms. Mood and anxiety disorders, secondary gains such as early retirement and financial compensations, must all be acknowledged by the physician as possible contributors to the symptoms. Abnormal illness behavior may better characterize patients with chronic pain syndromes. Behavior observation, which is akin to medical practice, is therefore a powerful tool in the diagnosis and management of these syndromes. Physicians ought be very careful in not reinforcing the patients already strong organic convictions regarding their symptoms, avoiding making decisions based on patients complaints and alleged disabilities, and assigning poorly defined and disputable diagnosis labels. Society needs also to refrain from policies that encourage abnormal illness behaviors.

Chronic Disease↗

[1st register of an epidemic caused by Oropouche virus in the states of Maranhão and Goiás, Brazil].

The authors describe the occurrence of outbreaks caused by Oropouche virus (ORO) in the states of Maranhão and Goiás, Brazil in 1988. 36 strains of the virus were obtained from the intracerebral inoculation of the blood of 120 patients into 2-3 day-old infant mice. The illness was characterized by headache, fever, pain in the muscles, joints and back, photophobia, retrobulbar pain, nausea and dizziness. 128 of 197 people examined in Porto Franco, MA, had hemagglutination-inhibiting antibodies to the agent, while 106 of them had IgM antibodies by MAC ELISA test. All age groups were infected, although the incidence was higher among who had 10 to 19 years old. There was no difference, in relation to sex infections. Recurrence of symptoms was reported in 56% of sick people. Mice inoculated with 3624 Culicoides paraensis (Ceratopogonidae) and 1970 Culex (Cux.) quinquefasciatus (Culicidae) collected in Porto Franco resulted in one single isolation of ORO virus, from the Culicoides. These are the first confirmed cases of ORO infection in Maranhão and Goiás states.

Adolescent↗