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PubMed2002

Developmental anomalies and disabilities associated with hypospadias.

PURPOSE: The incidence of developmental anomalies and disabilities associated with hypospadias is still a matter of controversy and data on this issue are sparse. We describe our experience with and evaluation of developmental anomalies and disabilities in a population in which posterior hypospadias was the most common anomaly. MATERIALS AND METHODS: We reviewed the records of 356 patients who underwent hypospadias repair from January 1986 through April 2000. Collected data included the Barcat classification of the hypospadias anomaly, anatomical penile variants, associated urogenital and extra-urogenital anomalies, and associated disabilities of physical and mental development. RESULTS: Of the 356 patients 234 (65.7%) had posterior, 88 (24.7%) anterior and 34 (9.6%) mid hypospadias. Anatomical variants, including penoscrotal transposition, bifid scrotum and micropenis, occurred predominantly in patients with posterior hypospadias, while penile torsion was present exclusively in the other 2 groups. Inguinal hernia, which was the most common urogenital anomaly, was distributed evenly among the 3 groups with a prevalence rate of 12.4%. Undescended testis in 26 cases (7.3%) was most often associated with posterior hypospadias. In order of frequency associated extra-urogenital anomalies included congenital heart disease in 19 cases (5.3%), musculoskeletal anomalies in 11 (3.1%), anorectal malformation in 6 (1.7%), cleft palate in 3 and other in 7. In 21 patients (5.9%) associated disorders were related to physical and mental development, including growth retardation in 6, cerebral palsy in 2 and psychological disorders that significantly impaired patient bodily function, behavior and performance in 11. Most extra-urogenital anomalies or disorders were associated with posterior hypospadias. CONCLUSIONS: Posterior hypospadias was the most common anomaly in this study. It was associated with a high rate of extra urogenital anomalies, and physical and psychosocial disabilities. The significance of the latter findings with respect to the development of affected patients needs further clarification.

Abnormalities, Multiple↗
PubMed1987

Varicella-zoster virus infections during pregnancy: hypothesis concerning the mechanisms of congenital malformations.

An analysis of the data on 52 infants whose mothers had contracted varicella during pregnancy revealed that 27 had congenital malformations ascribed to the maternal varicella infections, while another 25 developed herpes zoster in the early postnatal period. Most of the mothers whose infants had congenital malformations had contracted varicella within the first 20 weeks of gestation, whereas most of the mothers whose infants developed herpes zoster had varicella after 21 weeks of gestation. The clinical features of the various congenital malformations and dysfunctions after maternal varicella were diverse; however, there were peculiar segmental manifestations of anomalies of the skin, the peripheral nervous, the autonomic nervous, and the musculoskeletal systems, all of which receive common innervations from the same levels of the spinal cord. Most other dysfunctions may be ascribed to an encephalitis. Therefore, the mechanism of congenital malformations caused by varicella-zoster virus seems to be due not to fetal varicella but to the development of herpes zoster in utero and to an encephalitis associated with herpes zoster. At least one infant had congenital malformations that were due to maternal herpes zoster infection.

Congenital Abnormalities↗
PubMed1985

The development of cough.

Control of coughing is immature at birth; less than half of newborns cough spontaneously or on direct laryngeal stimulation. It is not known whether timing and distribution of motor outflow is optimized for muscle and lung mechanics. The musculoskeletal system is immature. Inspiratory and expiratory pressures appear to be adequate at birth, but the ranges of pressures and volumes actually used by infants during coughing are not well known. Lung structure is immature at birth. Low lung recoil pressures and low tracheal elastance (easy collapsibility) probably combine to reduce maximal gas velocities in uncompressed intrathoracic airways, and relatively low maximal expiratory pressures and high flow-resistive losses may combine to reduce maximal velocities in compressed regions of intrathoracic airways. Better descriptions of normal and pathologic aspects of structure and function are needed, with attention to control, motor, and lung mechanical functions during coughing and forced expiration in human infants. Application to the developing respiratory system of scaling techniques and models of forced expiration, and advances in understanding of two-phase flow in airways, would be helpful.

Cough↗
PubMed2001

[Interdisciplinary management of vasculitis patients: internist/rheumatologist].

Systemic vasculitides (SV) represent a heterogeneous group of different entities with varying clinical and pathological-anatomical characteristics that physicians of diverse disciplines are involved in the treatment of patients with SV. At the onset of disease organ manifestations often present as a single symptom without appearance of indirect signs of vasculitides as musculoskeletal complaints and constitutional symptoms indicating inflammatory systemic disease. Therefore early interdisciplinary care is extremely important to avoid major organ involvement with the development of fatal disease. Besides the multidisciplinary physical examination serological and immunological parameters, particularly in small vessel vasculitides are relevant in establishing the diagnosis. Regarding the interdisciplinary care we differentiate between primary diagnostic procedures and continuous follow-up to observe therapeutic and side effects of medications. Instruments for the assessment of disease extent (DEI), activity (BVAS) and irreversible damage (VDI) were developed in recent years to document prospectively the disease status and support activity-adjusted treatment. Because of the chronic relapsing character of systemic vasculitides, the measurement of health-related quality of life gained progressive interest in the longitudinal follow-up. In addition in these rare diseases early patient education with information on the disease, treatment, side effects and training in self management strategies will enable patients to actively participate in the management of their disease and bear responsibility.

Diagnosis, Differential↗
PubMed2006

Tissue engineering for the hand surgeon: a clinical perspective.

Hand surgeons may be faced with tissue shortages for reconstruction after trauma, tumor resection, or congenital deficiency. Tissue engineering is a developing scientific field that combines the principles of life sciences and engineering in developing biologic substitutes that will restore, maintain, or improve tissue function. This article reviews the general principles of tissue engineering as applied to musculoskeletal tissues including nerve, bone, tendon, skin, vessels, and cartilage and focuses on the application of tissue engineering that is relevant to clinical hand surgery.

Blood Vessel Prosthesis↗
PubMed2006

Common femoral artery injury secondary to tennis ball strike.

Tennis is a popular, safe sport that exposes amateur or professional players to minimal risk of injury. Most of this risk is related to musculoskeletal injuries, and vascular trauma is extremely rare. We present a case of a 68-year-old man in whom intermittent claudication developed after his right groin was struck by a tennis ball. The patient sought medical evaluation 2 months after the accident, and a subtotal occlusion of his right common femoral artery was disclosed by angiography and treated by endarterectomy.

Aged↗
PubMedDate not supplied

Tuberculosis.

Tuberculosis is caused by Mycobacterium tuberculosis, transmitted primarily by inhalation of aerosolized droplets containing the organisms. There is an infection of the respiratory tract and the tubercle bacilli spread via lymphatic system and bloodstream to many different organs. Generally, the pulmonary tuberculosis infections are asymptomatic and a positive skin test result is the only indication of it. Approximately 10% of infected individuals develop active disease. Immunosuppression caused by systemic diseases or medication increases the risk of developing tuberculosis. In addition to the pulmonary tract, tuberculosis may affect many organs and systems, including lymph nodes, larynge, middle ear, genitourinary tract, musculoskeletal system, central nervous system, gastrointestinal tract, pericardium, and skin. Ocular involvement is an uncommon event in tuberculous infection, and there are several presentations involving the iris, ciliary body, choroid, retina and optic nerve. The diagnosis is based in the detection of mycobacteria in fluids and tissues. If there is no available material for analysis, a presumptive diagnosis is made and therapeutic test initiated. The therapy is based in anti-tuberculous drugs and corticosteroids. The standard treatment protocol in Brazil includes isoniazid, rifampim, and pyrazinamid for two months, followed by isoniazid and rifampin for four months for susceptible organisms. Alternative regimens are necessary in the presence of drug resistance.

Antibiotics, Antitubercular↗
PubMedDate not supplied

Validity of occupational energy expenditure assessed by interview.

Measuring physical activity at work has been a field of growing interest in recent decades, and there is a need for reliable, standardized assessment instruments for application in large population studies. The present study examined the validity of a task-oriented interview for assessing energy expenditure in occupational work. The interview was developed for use in the MUSIC-Norrtälje study, a population study with the overall aim of identifying risk and preventive factors for musculoskeletal disorders. Twenty-seven persons were included in the study. Each respondent defined all tasks performed during a typical workday and estimated their durations. For each task the interviewer then assessed the level of energy expenditure in multiples of the resting metabolic rate (MET) and calculated a time-weighted average MET (TWA-MET) for a typical workday. Measurements of oxygen consumption and observations of duration of each work task were performed during 2 workdays in all the interviewed subjects. The validity was tested by comparing TWA-MET derived from the interviews with those derived from measurements; the product moment correlation coefficient was 0.70. The interview may offer sufficient validity for assessment of energy expenditure in large population studies.

Adult↗
PubMed2001

Overuse injuries in youth sports: biomechanical considerations.

Many children today participate in highly organized sports programs that involve regimented year-round repetitive training. This type of training has led to an increased incidence of overuse musculoskeletal injuries. Sports physicians have dealt with sports injuries in children for many years and, on the basis of their clinical experience, have developed guidelines to treat and to try and prevent these injuries. The purpose of this article is to provide a biomechanical perspective of sports injuries in young athletes and blend ideas from this perspective with more traditional clinical perspectives that dominate the literature relative to this topic. Basic tissue and gross movement mechanics principles are used to identify growth, morphological, and movement factors that may predispose a child to an overuse injury. Several biomechanical analyses of simple movement tasks are presented to quantify the forces developed in various tissues and to illustrate the effects that growth can have on these forces. Guidelines are given for developing injury prediction models that may be used in the future to establish safe and effective training guidelines for children.

Adolescent↗
PubMed2006

Tonic finite element model of the lower limb.

It is widely admitted that muscle bracing influences the result of an impact, facilitating fractures by enhancing load transmission and reducing energy dissipation. However, human numerical models used to identify injury mechanisms involved in car crashes hardly take into account this particular mechanical behavior of muscles. In this context, in this work we aim to develop a numerical model, including muscle architecture and bracing capability, focusing on lower limbs. The three-dimensional (3-D) geometry of the musculoskeletal system was extracted from MRI images, where muscular heads were separated into individual entities. Muscle mechanical behavior is based on a phenomenological approach, and depends on a reduced number of input parameters, i.e., the muscle optimal length and its corresponding maximal force. In terms of geometry, muscles are modeled with 3-D viscoelastic solids, guided in the direction of fibers with a set of contractile springs. Validation was first achieved on an isolated bundle and then by comparing emergency braking forces resulting from both numerical simulations and experimental tests on volunteers. Frontal impact simulation showed that the inclusion of muscle bracing in modeling dynamic impact situations can alter bone stresses to potentially injury-inducing levels.

Accidents, Traffic↗
PubMed1996

The effects of illness on quality of life: findings from a survey of households in Great Britain.

STUDY OBJECTIVE: To obtain national population norms on pertinent domains of quality of life, and the relative importance of these domains to people with reported longstanding illness. DESIGN AND SETTING: The vehicle for the study was the Office of Population Censuses and Surveys omnibus survey in Great Britain. The sampling frame was the British postcode address file of "small users", stratified by region and socioeconomic factors. This file includes all private household addresses. The postal sectors are selected with probability proportional to size. Within each sector 30 addresses are selected randomly with an target size of 2000 adults. PARTICIPANTS: The total number of adults interviewed was 2033 (one per sampled household), resulting in 2031 usable questionnaires, and representing a response rate of 77%. MAIN RESULTS: Of those who reported a longstanding illness, the most common, freely mentioned, first most important effects of the longstanding illness on their lives were (in order of frequency) ability to get out and about/stand/walk/go out shopping, being able to work/find a job, and effects on social life/leisure activities. Analysis of the areas of life affected by longstanding illness, showed considerable variation in relation to the condition. For example, respondents with mental health disorders (mainly depression) were most likely to report as the first most important effect the availability of work/ability to work, followed by social life/leisure activities; respondents with digestive and endocrine (for example, diabetes) disorders were most likely to report dietary restrictions; while respondents with cardiovascular disease, respiratory, and musculoskeletal disorders were most likely to report ability to get out and about/stand/walk/go out shopping. CONCLUSIONS: These results support the current trend of developing disease specific health related quality of life questionnaires rather than using generic scales.

Activities of Daily Living↗
PubMed1999

Bone and cartilage tissue engineering.

Tissue engineering of musculoskeletal tissues, particularly bone and cartilage, is a rapidly advancing field. In bone, technology has centered on bone graft substitute materials and the development of biodegradable scaffolds. Recently, tissue engineering strategies have included cell and gene therapy. The availability of growth factors and the expanding knowledge base concerning the genetics and regulation of bone formation have generated new materials for tissue-engineering applications. This information base also has benefited cartilage tissue engineering. The problems are more complex, however, and the solutions appear more elusive. Advances in scaffold design and cell culture have improved the prognosis for success.

Animals↗
PubMed2000

Hand and wrist injuries in young athletes.

Successful treatments of musculoskeletal injuries in the pediatric population demand a thorough understanding of the basic anatomy and its biomechanics, and the physiology of growth and development of the immature skeleton. In addition, good treatment outcomes rely on the treating physician being an effective teacher to the young athlete and the patient's parents, coaches, and trainers. At the same time, the physician must be a good student in learning the nature of the patient's sports and each patient's athletic ability and aspirations. Most pediatric hand and wrist injuries can be treated nonoperatively with proper immobilization techniques and activity modification, but cases requiring surgical intervention must be recognized promptly to avoid long-term complications.

Athletic Injuries↗
PubMed1984

Late effects of gastric bypass for obesity.

We studied 41 patients who had gastric bypass for obesity from 1974-1979. The procedure was well received by patients and most achieved adequate weight loss, but most subjects consumed inadequate diets and many developed iron and/or vitamin B12 deficiencies. Ten were anemic and 13 had been treated previously for postbypass anemia. Severely vitamin B12-deficient subjects did not respond to 50 micrograms oral vitamin B12 tablets, but those with milder deficiencies usually did. Schilling tests were usually abnormal and corrected when intrinsic factor was given. Many subjects developed manifestations compatible with osteoporosis due to inadequate calcium intake and absorption, and some also developed abnormal laboratory tests suggesting coexisting osteomalacia. Hematopoietic complications of gastric bypass can usually be prevented and are relatively easy to treat, but musculoskeletal complications may be more difficult to prevent and treat.

Adult↗
PubMed1994

[Reconstruction possibilities following resection of malignant musculoskeletal tumors].

Great advances have been achieved in the treatment of musculoskeletal tumors, and as a result limb-conserving resection is now possible in most cases. These advances are based on adjuvant therapy, development of histological criteria, new surgical techniques, and improved imaging methods. The use of computed tomography and magnetic resonance imaging has allowed more accurate preoperative staging. At the same time, an improvement in prognosis has also been achieved. After resection of the tumor, the following methods of reconstruction are available: reconstruction with no implant, endoprosthetic replacement, autogenous grafting, and allograft replacement. Postoperative monitoring is performed with plain-film radiography.

Bone Neoplasms↗
PubMed1993

[Late post-tracheostomy airway complications in patients with central nervous system injuries].

At decannulation or often weeks later some of the patients undergone long-term mechanical ventilation through tracheostoma reveal symptoms of airway stenosis. Posttracheostomy airway complications detected during the rehabilitation of 34 patients with central nervous system injury are presented. Endoscopic examinations (total 130) were performed with Olympus BF B3 and OES 20-type fiberscopes and Friedel-type rigid bronchoscopes under local or general anaesthesia. Stridor (20 cases) and possible decannulation (10 cases) were the main indications of the first endoscopic examinations. Stridor was caused by tracheal (12 cases) and laryngeal (8 cases) stenosis. With six patients decannulation was possible after the first endoscopy. Removal of granulomas and sutures was successful in 8 cases. Rigid bronchoscopic dilatations were temporarily successful in 7 cases, but in five of them it had to be repeated on emergency. Further therapeutic interventions were: recannulation (3 cases), retracheostomy (4 cases), implantation of silicon T-endoprothesis (5 cases), tracheal resection (4 cases). Three patients are discussed in details. Eliminating airway complications largely contributed to rehabilitation of the nervous and musculoskeletal system, improved the quality of life, and in acute cases it was a life-saving measure. In order to prevent the development of late airway complications or detect them in time, it is recommended to have an endoscopic protocol following every tracheostomy: 1. at the time of decannulation 2. at closing the trachea and 3. 2-3 months after decannulation.

Accidents, Traffic↗
PubMed2002

Managing musculoskeletal complaints with rehabilitation therapy: summary of the Philadelphia Panel evidence-based clinical practice guidelines on musculoskeletal rehabilitation interventions.

OBJECTIVE: The Philadelphia Panel recently formulated evidence-based guidelines for selected rehabilitation interventions in the management of low back, knee, neck, and shoulder pain. STUDY DESIGN: The guidelines were developed with the use of a 5-step process: define the intervention, collect evidence, synthesize results, make recommendations based on the research, and grade the strength of the recommendations. POPULATION: Outpatient adults with low back, knee, neck, or shoulder pain without vertebral disk involvement, scoliosis, cancer, or pulmonary, neurologic, cardiac, dermatologic, or psychiatric conditions were included in the review. OUTCOMES MEASURED: To prepare the data, systematic reviews were performed for low back, knee, neck, and shoulder pain. Therapeutic exercise, massage, transcutaneous electrical nerve stimulation, thermotherapy, ultrasound, electrical stimulation, and combinations of these therapies were included in the literature search. Studies were identified and analyzed based on study type, clinical significance, and statistical significance. CONCLUSIONS: The Philadelphia Panel guidelines recommend continued normal activity for acute, uncomplicated low back pain and therapeutic exercise for chronic, subacute, and postsurgical low back pain; transcutaneous electrical nerve stimulation and exercise for knee osteoarthritis; proprioceptive and therapeutic exercise for chronic neck pain; and the use of therapeutic ultrasound in the treatment of calcific tendonitis of the shoulder.

Acute Disease↗
PubMed2006

Update on guidelines for the treatment of chronic musculoskeletal pain.

Chronic musculoskeletal pain is a major - and growing - burden on today's ageing populations. Professional organisations including the American College of Rheumatology (ACR), American Pain Society (APS) and European League Against Rheumatism (EULAR) have published treatment guidelines within the past 5 years to assist clinicians achieve effective pain management. Safety is a core concern in all these guidelines, especially for chronic conditions such as osteoarthritis that require long-term treatment. Hence, there is a consensus among recommendations that paracetamol should be the first-line analgesic agent due to its favourable side effect and safety profile, despite being somewhat less effective in pain relief than anti-inflammatory drugs. Cyclooxygenase-2 (COX-2)-selective anti-inflammatory drugs were developed with the goal of delivering effective pain relief without the serious gastrointestinal (GI) side effects linked with traditional non-selective non-steroidal anti-inflammatory drugs (NSAIDs). Clinical trial evidence supported these benefits, and COX-2 inhibitors were widely adopted, both in clinical practice and in official guidelines. Recently, accumulating data have linked COX-2 inhibitors with serious cardiovascular and/or cardiorenal effects and/or serious cutaneous adverse reactions (SCARs), particularly at anti-inflammatory doses or when used long term. Regulatory authorities in both Europe and the USA have responded to these data with the withdrawal of rofecoxib and valdecoxib, and the strengthening of prescribing advice on all anti-inflammatory drugs. COX-2 inhibitors and non-selective NSAIDs should now be used with increased caution in patients at increased cardiovascular and/or cardiorenal risk, e.g., patients with congestive heart failure, hypertension, etc. Regulatory advice and good clinical practice are to use anti-inflammatory drugs at the lowest effective dose and for the shortest possible time. There are as yet no updated official guidelines that incorporate these new data and regulatory advice. An international multidisciplinary panel, the Working Group on Pain Management, has generated new recommendations for the treatment of moderate-to-severe musculoskeletal pain. These guidelines, formulated in response to recent developments concerning COX-2 inhibitors and other NSAIDs, focus on paracetamol as the baseline drug for chronic pain management; when greater analgesia is desired, the addition of weak opioids is recommended based on a preferable GI and cardiovascular profile, compared with non-steroidal anti-inflammatory drugs.

Acetaminophen↗