Biomedical subjects
Publications and source records attributed to N Maffulli.
A total of 416 gloves were tested for punctures after 200 episiotomy repairs. Evidence of perforation was found in 34 (8%) of the gloves used and in only half the cases did the surgeon actually realise that a perforation had occurred. The left index finger and thumb were more often perforated than other parts of the gloves. The implications of the findings, especially as regards spread of infections to surgeons, are discussed.
In 132 patients, fractures of the lower limb (71 femoral and 61 tibial fractures) were treated using interlocking nailing (ILN) according to Grosse and Kempf during the period 1986-1989. Of these, 118 were followed up for a median of 19 months (range 9-32 months). Inpatient stay averaged 9 days regardless of the fracture. Consolidation was achieved in approximately 3 or 4 months from the operation in tibial and femoral fractures, respectively. Tibial fractures were technically more demanding than femoral ones, and their average operating time was significantly longer (73 min versus 51 min). Only one patient had a malunion in malrotation. The most serious complication was in a closed upper tibial fracture with traumatic rupture of the popliteal artery. Although the nailing was technically successful, an above-knee amputation had to be carried out. In only one case did the nail fail, and tibial plating had to be performed. Given the present degree of expertise, ILN for fractures of the long bones of the lower limb is a safe and relatively easy procedure to perform.
An increasing number of children undergo intensive training routines and high level competition from an early age. Although physical training may foster health benefits, many are injured as a result of it. Carefully controlled studies on the effects of training routines from childhood are however lacking. This paper reviews some of the effects of training in young athletes, focusing on physical, cardiovascular and muscular effects, and sports injuries. Psychological effects of intensive sports participation are briefly considered. Measures should be taken to modify the present structure of competitive sport to avoid the possible deleterious effects of intensive physical activity on children.
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Nine patients (age 8.9, range 6.5 to 9.5 years) with idiopathic haemihypertrophy were followed at six month intervals for two years. The isometric voluntary contraction strength of the elbow flexors and knee extensors was measured bilaterally, and expressed per unit of muscle and bone cross sectional area of the upper arm (elbow flexors) and of the mid thigh (knee extensors). In absolute terms, the hypertrophic side was always stronger, and the increase in strength was strongly correlated with the increase in limb size bilaterally (P less than 0.01). The hypertrophic limb always exerted greater isometric strength, but if strength was standardized for an anthropometric estimate of upper arm and mid thigh cross sectional area, the normal and hypertrophic side were not significantly different. The limb length discrepancy, when expressed in percentage, remained constant at approximately 3%.
Two mature elite Sambo wrestlers were studied during a 22-day pre-European Championship period, during which they were to lose weight and maintain their top physical performance characteristics. During this time the athletes underwent intensive training coupled with a hypocaloric diet. Both lost approximately 8% of their initial body weight, while maintaining their pre-weight loss maximum oxygen uptake, anaerobic threshold and maximum isometric strength. These variables therefore increased when expressed relative to the lower body weight. Isometric endurance and short-term sprinting ability, however, were compromised by the weight-loss regimen, decreasing by up to 7% and 13% respectively. Following a well-planned weight-reduction programme coupled with serious training, aerobic power and isometric strength were unaffected and/or improved, but prolonged anaerobic exercise performance was impaired.
Fifty-two knees were examined using real-time high-definition ultrasonography with a 7.5 MHz probe. The extra-articular structures were easily visualized and diagnosis of patellar tendon lesions and Baker's cysts formulated. While the meniscal cartilages were shown as a homogeneous triangular structure between the femoral condyle and the tibial plateau, no lesions were detected. Deeper intra-articular structures, such as the cruciate ligaments, were not shown by the scan, thus their evaluation was not possible. Given its low cost, wide availability, non-invasiveness and patients' acceptability of the technique, ultrasonography may play an important role in the diagnosis of soft tissue lesions in and around the knee joint.
A 26-year-old male canoeist was referred with a 10-day history of abdominal pain, and a palpable mass in the left upper quadrant. No history of direct trauma was given. He was not taking any medication, and malignancy and inflammatory conditions were considered in the differential diagnosis. Ultrasonographic scan identified a mass originating in the rectus abdominis sheath. Ultrasonographically guided aspiration yielded some partially clotted blood, confirming the clinical diagnosis of rectus sheath haematoma. After conservative treatment, the patient resumed training, and is fully asymptomatic 1 year after discharge.
The histochemical composition of the triceps surae muscle was investigated in 13 previously unoperated children (age 9-24 months) with unilateral idiopathic clubfoot. On both the normal and the affected side, the percentage of type I fibers was significantly higher than that of the other fiber types. The muscle biopsies from the clubfoot side showed an increase in their connective tissue content. The affected side showed a nonsignificant higher percentage of type I fibers, whereas the average capillary density and capillary to fiber ratio were significantly lower.
Limb lengthening in nine patients was monitored by radiographs and by ultrasound scans. The distraction gap appeared as a sonolucent area within which echogenic foci developed soon after distraction commenced. By seven weeks a new cortex was detected, and medullary canal began to develop between seven and eight weeks. Ultrasound scanning can be used to measure distraction, but it was not as useful as radiographs in detecting angulation. Its use in patients undergoing limb lengthening could reduce their exposure to radiation.
We report overuse injuries in 14 elbows of ten élite young gymnasts. In 12 elbows of eight patients aged 11 to 15 years there was a spectrum of radiological abnormalities including widening of the olecranon physis and fragmentation of the epiphysis. The radiographs were compared with those of normal elbows matched for age and sex. The radiograph appearances were very similar to those of the Osgood-Schlatter lesion of the tibial tuberosity. Two older boys, aged 18 and 19, had stress fractures through the olecranon growth plate. Conservative management was successful in all except one case of stress fracture which required internal fixation.
Sporting activities impose on the skeletal system forces of a high intensity and frequency. Ligaments, bone and tendons behave in a time-dependent load-extension fashion, and it is important for both scientists and clinicians to consider, for example, the alterations in failure properties shown by ligaments, tendons and bone at different rates of deformation. Whether the ability of the skeletal system to withstand stress can be improved with appropriate training is still controversial. The effects of physical exercise depend on the modality, intensity and duration with which the exercise itself is performed. Moreover, genetic factors, also influencing growth and hormonal status, may exert a significant influence on the response of a given tissue to an external load. Overloading may cause a lesion, and this may decrease or annihilate performance capability. The skeletal system may not be resistant enough, and so it may prove limiting to intensive physical activity. In vitro studies on resistance of a single tissue have not taken into consideration the specific resistance of that structure in vivo, and the results so obtained cannot be readily extrapolated to sporting activities, as in vivo muscles, joints, tendons, ligaments and cartilage act as one. This article reviews some of the possible beneficial and detrimental effects of intense exercise on various components of the skeletal system, focusing on its ability to withstand and adapt to stresses and allow maximal performance.
We report a case of dorsolumbar spine duplication in a female patient. She had several vertebral anomalies, such as fused vertebrae, hemivertebrae and butterfly vertebrae, together with duplication of the spinal column in the lower thoracic and the whole lumbar tract. Clinically, she had no control of the sphincters, but her gait was only slightly affected. This is probably the third reported case of this rare anomaly.
Following surgical exploration, a swelling on the back of a boy's hand was thought to be a tuberculous granuloma and was treated as such. Eleven months later, when the lump was re-explored, a plant thorn was retrieved from the middle of a foreign body granuloma. Even though a definite history of trauma is not given, an organic foreign body lesion should be considered in the differential diagnosis of a lytic lesion of bone.
Ten eumenorrheic nonathletic women, aged 21-25, were studied on the 8th day following the LH peak in three consecutive cycles. Plasma level and metabolic clearance rate (MCR) of estradiol (E2) and progesterone (P) were measured before and during a 2-h continuous treadmill test at a speed corresponding to 70% of their running speed at anaerobic threshold on three separate occasions. A significant decrease of plasma level of the hormones (-30% and -40%, respectively, P less than 0.01; mean) from resting values was found, while their metabolic clearance rate increased significantly [E2-MCR from 1017 l.d-1 to 1312 l.d-1 (+29%), P less than 0.001; mean; P-MCR from of 2061 l.d-1 to 2988 l.d-1 (+45%), P less than 0.003; mean]. The increase in MCR of the two hormones was significantly correlated with the increase in heart rate and systolic blood pressure accompanying the beginning of the exercise test.
Quantitative measurement of spinal deformity is the preliminary step in order to plan a therapeutic regimen. The most commonly used methods and, for this matter, practically any measurement methods, may have several sources of errors, namely: a. errors in taking a radiograph; b. errors intrinsic to the measurement method; c. errors due to anatomical deformity of the vertebrae; d. observer errors in measurement technique. These are discussed, and suggestions are given to minimize them.
Thirteen radiographic methods to measure spondylolisthesis were assessed to determine: 1. whether or not the different methods were correlated with each other; 2. their precision in detecting vertebral displacements; 3. inter- and intra-measurer reliability among six orthopedic surgeons performing radiographic measurements. Several methods were found to be correlated with each other in detecting spondylolisthesis on radiographs. However, on simulated displacements only three of them showed good correlation (r greater than or equal to 0.95, p less than 0.01). Intra- and intergroup correlations among the orthopedic surgeons were equally good (r greater than 0.90; p less than 0.01).
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