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Undetected cardiac lesions cause unexpected sudden cardiac death during occasional sport activity. A report of 80 cases.

The retrospective analysis of 1500 forensic autopsies after sudden cardiac death showed that 80 (77 men, three women) had died following sport, for which they had been inadequately trained. The chosen sport (both dynamic and static), and the cardiac pathology discovered during autopsy make it possible to divide the population into two groups. Group 1 were those under 30 years of age (27 cases) engaged in jogging, gymnastics, rugby, tennis and boxing who suffered from hypertrophic cardiomyopathy (29.6%), arrhythmogenic right ventricular cardiomyopathy (25.9%), non-atherosclerotic (14. 8%), aortic stenosis (7.4%), atrial septal defect (3.7%), stenosing coronary atherosclerosis (3.7%), and structural abnormalities of the His bundle (3.7%). Group 2 were those over 30 years of age (53 cases), engaged in swimming, cycling, jogging and football. The cardiac lesions responsible were stenosing atherosclerotic coronary disease (49%), non-atherosclerotic coronary disease (1.8%), hypertrophic cardiomyopathy (20%), obstructive cardiomyopathy (4.8%), structural abnormalities of the His bundle (7.4%), myocardic bruise scar (4%), and arrhythmogenic right ventricular cardiomyopathy (3. 7%). In both groups, dilated cardiomyopathy occurred with identical frequency (11%).Conclusions The lesions discovered are the same as those identified in professional athletes, when the body tries to avoid mortal rhythmic decompensation in the case of an over-loading volume and tension during an ill-adapted effort. Forensic autopsy should establish these anomalies because the transmissible genetic characteristics of some of them could underline the need for check-ups in other members of the family.

Adolescent↗

[Synovectomy in the prevention of recurrent joint bleedings in haemophilia (author's transl)].

Synovectomy was performed in seven patients with severe haemophilia A, one with moderately severe haemophilia A and one with severe haemophilia B. Frequently recurring haemorrhages into one knee and demonstrated hypertrophic synovitis were the indications for operation in all. No serious bleeding complications occurred during or after the operations. After synovectomy the frequency of haemarthroses in the synovectomised joint decreased significantly. Satisfactory joint function was eventually achieved in all by gymnastic exercises and physiotherapy over a long period. The operation should only be done in large haemophilia centres were there is sufficient experience.

Adolescent↗

Metabolic and cardiocirculatory reactions after concentric and eccentric exercise of the shoulder.

Lower metabolic and cardiocirculatory reactions to eccentric compared to concentric exercise are known for large muscle groups. The extent of exercise reaction depends on the muscle mass involved and moreover differs between the various muscle groups, while it is unclear to which extent cardiovascular and metabolic reactions and differences between the types of work exist in the shoulder, also it is not known whether these reactions differ according to training status. Lactate production (LA), heart rate (HR), and blood pressure (BP) were examined following eccentric and concentric shoulder movements in 16 male gymnasts (GN) and 15 male untrained subjects (US). Differentiation was made according to the types of work for peak torque (PT) and local muscle endurance (LME). Following eccentric exercise, the increase of LA and HR was clearly lower than following concentric exercise (p<0.05). No difference was observed between the groups. Diastolic BP showed no changes, whereas systolic BP was higher following concentric exercise. Eccentric PT was higher than concentric PT in GN within a test-retest variability of 15%. LME showed a lower degree of fatigue under eccentric conditions, independent of the group. It is concluded that eccentric exercise of the shoulder leads to lower metabolic and cardiocirculatory reactions than concentric exercise, in spite of higher peak torque and less fatigue. Exercises consisting of a high proportion of eccentric movement may thus be beneficial in the therapy of shoulder complaints, especially in patients with cardiovascular disease.

Adult↗

Spondylolysis as a cause of low back pain in swimmers.

Low back pain (LBP) has recently become a common complaint in swimmers. The differential diagnosis of LBP in swimmers includes muscle and ligament sprains, Scheuerman disease, herniated disc, facet joint injury, tumors, infections, and spondylolysis. Although spondylolysis or listhesis is a frequent injury in the athlete, mainly in weightlifters, wrestlers, gymnasts, divers and ballet dancers, it is infrequently reported in swimmers. We have recently encountered four adolescent elite swimmers who complained of low back pain and were diagnosed as having spondylolysis. Three of the patients were either breast-strokers or butterfly swimmers. Plain radiography demonstrated the lesion in two patients. Increased uptake in bone scan was noted in all patients. CT was performed only in two patients and revealed the lesion in both. One patient was diagnosed within two weeks, and the diagnosis in the others was deferred for 2-7 months. The patients were treated successfully by reducing the intensity of their training program and the use of a corset for at least three months. Repeated hyperextension is one of the mechanisms for spondylolysis in athletes as is the case in breast-strokers and butterfly style swimmers. LBP in swimmers should raise the suspicion of spondylolysis. Plain radiography and bone scan should be performed followed by SPEC views, CT, or MRI as indicated. If the case is of acute onset as verified by bone scan, a Boston or similar brace should be used for 3 to 6 months in conjunction with activity modification and optional physical therapy. Multidisciplinary awareness of low back pain in swimmers, which includes trainers, sport medicine physicians, and physical therapists, should lead to early diagnosis and appropriate treatment.

Adolescent↗

[Inline skating in school--perspectives from the sports medicine viewpoint].

INTRODUCTION: Children are motivated by new activities in physical education. Inline Skating (ILS) is one of the trend activities of the last years. For the establishment of ILS in school injury risks and the possible preventive transfer in leisure time activities are of interest. The aim of this study was to compare the incidence of injuries in an ILS-program in school with traditional activities of exercise lessons. Furthermore inline skate specific injury incidence in leisure time was evaluated. METHOD: A sample of 47 schools was evaluated by a standardized questionnaire asking for: injury incidence in traditional sports and ILS and the incidence of ILS-injuries in leisure time. RESULTS: The relative injury risk of ILS (% per 100 teaching units) is 14.3%. Basketball e.g. has an injury risk of 16.1%, handball 14.6%, gymnastics 13.9% and other games 9.5%. After the end of the ILS-program 37.3% of the students reported the incidence of an injury due to ILS in leisure time. CONCLUSION: Compared to other activities in physical education ILS shows a moderate risk of injury and may improve the acceptance of active and passive prophylaxis.

Adolescent↗

Magnetic resonance imaging of the wrist.

Optimal magnetic resonance (MR) imaging of the wrist requires a high field strength magnet and a dedicated wrist coil to achieve high-resolution images. Using current MR sequences, detailed images of articular cartilage and the supporting ligaments and tendons can be obtained. Evaluation of the triangular fibrocartilage as well as the extrinsic and intrinsic ligaments of the wrist is possible with thin-slice three-dimensional volumetric gradient recalled sequences. Fast inversion recovery sequences, used to achieve fat suppression in peripheral joints such as the wrist, allow for detection of acute osseous trauma, which is often radiographically occult. Cartilage-sensitive imaging allows for evaluation of conditions in the skeletally immature patient, such as chronic physeal loading in the adolescent gymnast, as well as detection of the sequelae of altered biomechanics in the adult, as in the ulnolunate impaction syndrome. Moreover, contrast-enhanced magnetic resonance angiography permits a relatively noninvasive evaluation of peripheral vascular disease, obviating the need for an intraarticular injection.

Adolescent↗

[The reconstruction of rectal atresia. Diagnostics, therapy and prognosis of anorectal malformations].

The reconstruction of rectal atresia. Diagnostics, therapy and prognosis of anorectal malformations. The reconstructive operations of anorectal malformations are aimed on the establishment of anatomical correct position of the anus and the elimination of existing urethral or cutaneous fistulas resulting in a regular fecal continence. The favourite surgical method of operation is the posterior sagittal approach by Pena, in high-type anorectal malformations the endorectal pull-through by Rehbein can also be recommended. The assessment of fecal continence of the low-type forms is satisfactory good compared to high-type. It mainly depends on the localisation of these defects and on the experience of the surgeon. With the exception of not accurate placement of the neorectum respectively neoanus secondary surgical intervention to improve the fecal continence should be used only after applying all conservative methods, like perineal gymnastics, electrostimulation and biofeedback training.

Adolescent↗

[Influence of sports mechanic demands in competitive tennis on the thoracolumbar spinal profile].

The aim of this study was to evaluate the influence of the sports mechanic demands of competitive tennis on the thoracolumbar spinal profile. For that reason the spinal curvature (C7 - S2) of 123 male active gymnasts aged 23,8 +/- 4,5 years with a sporting exposure of 14,4 +/- 3,8 years and of 1347 age and gender matched non- and recreational sportsmen was recorded by means of the non-invasive ultrasonic-controlled contact rod. In the sagittal projection no differences between both groups were found. However, in control and sports group the dominant side of the arms induced statistically significant differences for all parameters describing spinal curvature in the frontal and transversal plane, data evaluated showed a relevant increase in the tennis group. Furthermore, the criterion both-handed hitting technique in fore and backhand caused an additional extension of lateral inclination, pelvic and pelvic-shoulder tilt as well as pelvic-shoulder rotation to the hitting side of the arms. After examining the sports-specific mechanic strain the measuring values are to interpret as a functional adaptation to the tennis-specific demands. But there is only a reduced correlation with the results of epidemiologic studies taking the incidence and prevalence of spinal injuries in competitive tennis into special account. So the tennis-specific modifications of spinal profile are not to characterise a priori as pathogen.

Adult↗

[Combined lateral ankle and calcaneocuboid joint instability].

Up to now there was no publication describing a combined instability of the calcaneocuboid and lateral ankle joint. A 38 years old teacher (a former gymnast) complained about increasing giving way symptoms and pain at the lateral foot and ankle. Because of this, he was unable to take part in sports activities. Clinical investigation revealed lateral ankle and calcaneocuboid joint instability. Surgical treatment was done using periosteal flap augmented capsular reefing for both joints, resulting in full ability in sport and profession four months later.

Adult↗

[Volleyball sport school injuries].

INTRODUCTION: Ball sport school injuries account for a significant morbidity among children and adolescents. Volleyball is popular in school sport and leads frequent injuries in youth besides basketball and soccer. METHODS: During a school year 2234 school sport injuries have been reported to the Gemeinde Unfall Versicherung (GUV) from all schools in Niedersachsen, Germany. The major disciplines were ball sport injuries, accounting for 59.5 % (1330 accidents), Gymnastic sport injuries follow at second position accounting for 18 % (403 accidents), followed by athletics with 8.1 %. RESULTS: Regarding the non-gender-specific distribution of the ball sport disciplines, basketball leads with 32.4 % (431 injuries), followed by soccer (23.8 %, 316 injuries), volleyball (17.4 %, 232 injuries), small ball games (11.2 %, 149 injuries), handball (8.3 %, 110 injuries), and hockey (4.9 %, 65 injuries). In boys, volleyball accounts third among the ball sport injuries (10 %, 63 injuries), after soccer (38 %, 245 injuries), and basketball (28.5 %, 185 injuries). In girls, volleyball was the second major ball sport injury discipline (24.8 %, 169 injuries) after basketball (36.1 %, 246 injuries), followed by small ball games (12.9 %, 88 injuries), and soccer at 4 (th) position (10.4 %, 71 injuries). The analysis of the distribution of injury during volleyball accidents dominate upper extremity injuries (71.3 %), with special emphasis on finger injuries in 53 %, followed by lower extremity injuries (21.5 %) and head injuries (4.3 %). Spine injuries were rare (0.9 %). The type of injury during volleyball school sport injuries were predominantly sprains (21 %), ligament distorsions and ruptures (20 %), fractures (17 %), and bruise (16 %). Analyzing the circumstances of the injuries, most injuries during volleyball school sport occurred without a opponent contact during ball contact (59 %), followed during movements (9 %), the landing phase (9 %), and after a strike of the ball (7 %). CONCLUSION: Volleyball injuries account for a significant number of all school sport related injuries. Upper extremity injuries account for the vast majority of all injuries especially during individual game play. Blunt trauma and fractures are most prevalent among school sport injuries in soccer. Preventive measures such as preservation of a high level of attention when scheduling a sport lesson, safety measures, and awareness of the possible severe injuries and knowledge in basic life support are mandatory to implement in school sports, since ball sport is proven to be very valuable for the physical and psychological development of the children. The role of preventive finger taping in volleyball school sport has to be evaluated in prospective clininal trials.

Adolescent↗

Thicker radial cortex in physically active prepubertal girls compared to controls.

This study was carried out to investigate the effects of physical activity on cortical bone of the radius in a population of prepubertal girls. Forty-nine healthy girls, 17 actives (10.62 +/- 1.56 years) and 32 controls (9.84 +/- 1.23 years) participated in this study. The active group was involved in gymnastics, judo, and dance on average 7.76 +/- 3.94 h/week. Bone mineral content (BMC) and density (BMD) were performed at the distal third of the non-dominant radius using DXA. The lean mass of the non-dominant forearm was derived from the total body analysis performed with DXA. In order to obtain bone cortical thickness, standard radiographs of the non-dominant radius were scanned and computed using a software program based on radiogrammetry. BMD and BMC values were higher in actives than in controls. Cortical thickness at the ulnar side correlated significantly with all the anthropometric and densitometric values as well as the duration of training. In addition, cortical thickness at the ulnar side was significantly higher in the actives compared to the controls. After adjustment for the duration of training per week, cortical thickness of the ulnar side did not differ any more between actives and controls. The same observation was obtained after adjustment for the forearm lean mass. In our active population, physical practice seemed to have induced greater BMC and higher cortical thickness than those observed in the sedentary.

Absorptiometry, Photon↗

[Cardiac rehabilitation--expectations and appraisals of patients].

Patients' expectancies are widely hypothesized to influence the course of rehabilitation. Therefore, an exploratory cross-sectional survey was performed in cardiological rehabilitation patients to analyse the relationships of patients' expectations and rehabilitation outcomes. Patients were recruited from ambulatory heart groups (phase III rehabilitation). All participants judged both their expectations and experiences regarding their inpatient rehabilitation (phase II) in retrospect. Of 300 eligible heart group members, 238 (79 %) consented to participate (81 % male; mean age 65.5 years). Discussions with their physician, in-depth clinical examination, and information regarding treatment and healthy life-style were rated as most important by the patients. Nutritional counselling, gymnastics, massage, walking and the pleasant surroundings of the clinic were also frequently mentioned. One third stated that they had changed their attitudes regarding life-style, stress management, and nutrition as a result of rehabilitation. However, according to their self-reports, changes in body weight were not substantial whereas the proportion of smokers declined. 70 % reported to be interested in attending a future rehabilitation treatment. Patients with high expectations regarding physical training, health counselling, behaviour modification and physician care had better rehabilitation outcomes. When interpreting the results, both the selective nature of the sample and possible recall bias due to the retrospective assessments have to be considered. Our findings may thus be seen as hints as to patients overall judging their rehabilitation in a positive way. However, critical aspects were also mentioned. While these did not touch the general concepts of the interventions, they highlighted specific aspects of its performance and implementation, issues that should be taken into account by the individual rehabilitation clinic.

Attitude to Health↗

Effect of physical fitness and endurance exercise on indirect biomarkers of recombinant growth hormone misuse: insulin-like growth factor I and procollagen type III peptide.

Serum insulin-like growth factor-I (IGF-I) and procollagen type III peptide (P-III-P) have been proposed as indirect biomarkers of rhGH misuse in sports. The purpose of the present study was to investigate concentrations of these biomarkers in athletes at different levels of physical fitness and endurance exercise. Serum total IGF-I and P-III-P were measured in 96 elite athletes of various sports along the training season; in 21 recreational athletes at baseline non-exercising conditions and in another 129 recreational athletes before and after long-distance races (10 and 21 km). No differences were evidenced for IGF-I concentrations, but statistically higher values of serum P-III-P were found in elite athletes compared to recreational ones. Among elite athletes, the specific sport did not affect serum IGF-I. However, P-III-P was statistically higher in the sport performed by the youngest athletes (rhythmic gymnastics), even after correction of the logarithm of the concentration by the reciprocal of age. Over the training season, the within-athlete variabilities of IGF-I and P-III-P in elite athletes were low (22.8 % and 21.7 %, respectively). Recreational athletes taking part in a 21 km competition race showed a significant increase in serum values of IGF-I and P-III-P immediately after the event. Exercise workload and age had a significant effect on serum concentration of P-III-P, while age alone affected IGF-I serum concentrations. Therefore, athlete's reference concentration ranges for doping detection should include subjects from as many different ages and sports as possible.

Adolescent↗

[Avascular necrosis of the capitate in athletes].

The possibility of osteonecrosis of the carpal bones should always be considered when athletes present with pain of unknown origin in the hand and wrist, in particular, if they are participating in sports such as gymnastics or weight-lifting that involve extreme loading of the wrist with axial compression and microtrauma. This sort of extreme loading of the wrist combined with a constitutionally "weak" blood supply to the individual carpal bones may lead to the formation of osteo-necrotic zones. A treatment method that can produce excellent results, depending on the pathomorphology, is available in the form of vascularized bone grafting.

Adult↗

Femininity control at the XXth Universiade in Kobe, Japan.

In 1985, we were in charge of the femininity control tests for the participants of the XXth Universiade in Kobe. At that time, we chose as screening tests checking both X chromatin from buccal mucous membrane and Y chromatin from hair roots. The number of female competitors who attended the Universiade, except tennis, gymnastics, and fencing, was 631. Among them, 108 had already had the certificate of femininity so we examined 523 female competitors. All but three of them were normal for femininity, i.e., X chromatin positive and Y chromatin negative. Two of the three exceptions were Y chromatin positive and X chromatin negative. Chromosomal analyses from their peripheral lymphocytes showed a pattern concordant with a 46,XY karyotype. The other was both X and Y chromatin positive, but we could find Y chromatin on only one slide out of three. Since this person refused to have a blood sample taken, we can only suppose her karyotype as being 46,XX/46,XY or 46,XX/47,XXY. This last case would not have been found, if we had checked only the X chromatin. From our experience, we conclude that for femininity control, it is safer to screen the Y chromatin. We would strongly advise the use of both X and Y chromatin tests for femininity control.

Female↗

Incidence rate of injuries during sport activity and physical exercise in a rural Swedish municipality: incidence rates in 17 sports.

A prospective study of acute injuries from sports and physical exercise was carried out during 1 year in a total population of a municipality with 31,620 inhabitants. Data on exposure were collected: the number of participants in each sport, the hours of participation, and number of weeks in the season per year. The number of injuries was used as numerator and the exposure data as denominator in a formula modified from Chambers for the calculation of population at risk in sports. A total of 571 injuries occurred in 28 different sports: 65% of the injured were males. The majority of the injuries were from soccer: 50% of the males and 27% of the females. Incidence rates in 17 sports are presented. The ranking order differs, when calculating not only the number, but also the exposure. Ice hockey and handball were then found to have the highest risk followed by soccer. Team and contact sports on the whole had the highest rates in both genders. As a group, intercompany players had the highest rate, especially in soccer. The lowest rates were found in individual sports such as downhill skiing, horseback riding, racket sports, and running. Gymnastics, except in school physical education, had no injuries at all. Sprains and strains were diagnosed in nearly half of the cases and the foot and ankle were the most frequent sites. Preventive measures are proposed.

Adolescent↗

[Sports and physical load bearing capacity after spondylodesis in patients with Scheuermann kyphosis].

In this investigation it was examined which is the effect of an extensive spondylodesis by patients with Scheuermann's kyphosis on their sport activity and their physical load capacity. Between 1983 and 1990, 10 patients with severe kyphosis secondary to Scheuermann's disease underwent surgical correction and spinal fusion. In 1997 all 10 patients were clinically and radiologically examined and interviewed at an average follow-up of 9.6 years. At the time of follow-up one patient was active in top sports, seven patients in normal sport, two patients were members in a sports-club and one patient was not interested in sport. Eight patients went in for sports regulary. Mostly the patients were active in gymnastics, cycling and swimming. At follow-up almost all patients found that their physical load capacity and the behaviour in relation to back pain were better than before operation. Half of the patients were exposed to a middle physical load in the daily life. The presented study shows that patients after extensive spondylodesis for Scheuermann's kyphosis and clear reduction of pain are not automatically limited in the daily life, both for sport and professional activity. However, generalized recommendations for the physical load capacity of the operated patient cannot be given, and an individualized decision must be taken for each case.

Adolescent↗

[Monteggia injuries in athletes. Causes, classification, results].

Monteggia-fractures are serious combination injuries to the forearm. Sport injuries are being increasingly observed; the reason for this, besides the general expansion of mass sports, is the increasing burden of high-performance sports. Monteggia fractures can occur during a fall on an outstretched arm, for example in motor or bicycle sport injuries, but also when falling from gymnastic equipment. Generally, it is easy to diagnose the monteggia injury. Considerable secondary damage could occur from the frequent failure to notice the involved radiohumeral joint. It should be demanded that in case of an uluar fracture the adjoining joints should be x-rayed on two planes in order not to overlook the possibility of a chisel fracture. The different forms of this combination injury, its classification and the results of our own medical bulletins are presented.

Athletic Injuries↗