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At least 757 records · Page 42Linked to original sources

PubMed1990

Pathologic findings and pathogenesis of racetrack injuries.

Many lesions of the musculoskeletal system of racing horses are either acute traumatic lesions or are chronic biomechanically induced lesions that become suddenly unstable and provoke acute clinical signs. The latter lesions along with those of DJD are much more common and are of much greater overall economic importance to the racing industry than are the acute traumatic injuries. Chronic biomechanical lesions occur at predictable sites and are the result of an imbalance between repetitive microtrauma sustained in athletic performance and adaptive repair mechanisms of skeletal tissues. The distribution of these lesions in the limbs reflects the patterns of biomechanical forces placed on the skeleton during work at racing speeds and, therefore, reflects the type of racing activity for which the horse was bred. Lesions result when there is a failure of the stressed skeletal structures to adapt to the biomechanical forces placed upon them. Rest or a reduction in the level of training activity permit the healing of many asymptomatic and presumably some symptomatic lesions of the bony tissues. Articular cartilage, tendons, and ligaments have a lower capacity to resolve the damage and return to normal structure and function.

Animals↗

PubMed2002

Adaptive and phylogenetic influences on musculoskeletal design in cercopithecine primates.

Broad allometric studies of the musculoskeletal system have frequently sought to explain how locomotor variables have been influenced by body mass. To examine animals that vary widely in body mass, these studies have included taxa that differ in their locomotor adaptations and phylogenetic relatedness. Because these sources of diversity could obscure the effects of body mass, this study was designed to test the effects of adaptive differences in limb proportions and phylogeny, as well as body mass, on locomotor kinematics and extensor muscle mechanical advantage. More specifically, two hypotheses were tested in a sample of closely related animals: (i) that, among animals with similar body mass, those with longer limb segments should adopt more extended limb postures to moderate the joint and midshaft bending moments that they experience, and (ii) that body mass will have similar influences on joint posture and joint moments in closely related and diverse mammalian samples. Three-dimensional kinematic and synchronous force-platform data were collected for six individual cercopithecine monkeys ranging in mass from 4kg to 24kg and at a range of walking speeds. Comparisons among three monkeys with similar body mass but different limb segment lengths reveal a significant effect of limb proportion on posture. That is, animals with longer limbs frequently use more extended limb postures and can have correspondingly lower joint moments. The scaling of locomotor variables across the entire sample of closely related monkeys was generally similar to published results for a diverse sample of mammals, with larger monkeys having more extended limb postures, lower joint moments and greater effective mechanical advantage (EMA) for their limb extensor musculature. Ankle EMA, however, did not increase with body mass in the primate sample, suggesting that clade-specific adaptive differences (e.g. the use of arboreal supports by primates) may constrain the effects of body mass.

Adaptation, Physiological↗

PubMed2006

Assessing the instrumentalist interface: modifications, ergonomics and maintenance of play.

Awareness of the tasks required to play a particular instrument requires observation of technique and understanding of the dynamic and static loads placed on the musculoskeletal system to play a particular instrument. Anatomic differences, variation in hand size, gender, instrument choice, and maintainance of the instrument all may play a role in the development of playing-related complaints. Simply observing particular instruments, we can see a variety of positions that are required to play the instrument. Important to the discussion of overuse syndromes, we must evaluate the duration of practice sessions and warm-up and cool down periods, which may help minimize playing-related problems. Avoid absolute rest and opt for relative rest for playing-related problems. Immobilization for more than 3 to 4 weeks may lead to greater risk of injury when playing is resumed. Return to play schedules should start with simple, soft music, doubling minutes of playing every few days, dropping back if pain develops. Practical advice may include building up practice times gradually with 5- to 10-minute intervals in 60- to 90-minutes sessions. This recommendation is supported by the findings of Lutz and colleagues who showed decreased blood flow to the forearm after repetitive hand and wrist activities for 90 minutes. This decrease in blood flow normalized after 5 to 10 minutes of stretching exercises. Players with hypermobility should consider limiting practice sessions to 45 minutes allowing for rest breaks of 10 to 15 minutes. Fry suggested a shift in thinking of ergonomics as sa reactive strategy to one in which we anticipate and prevent problems before they become insidious or severe enough to limit the ability of the instrumentalist to play. Joint protection is important in all musicians, and although youth can be forgiving for many, we must remind our patients about joint protection as it applies to activities of daily living. Instrumentalists rely on their hands and finger joints to allow them to perform. Basic principles that apply to patients with all types of arthritis also apply to our patients when activities that worsen symptoms or place unnecessary stress on joints are identified. Using adaptive equipment to open jars is an obvious example. Overall, engaging the patient to observe routine behaviors may lead to the identification of modifiable activities, which might be aggravating or manifesting as a playing-related discomfort. Although some injury patterns can be associated with particular instruments, remember that your guitar-playing patient may be taking drum lessons on the side, Which could result in lateral epicondylitis that bothers him when he plays the guitar.

Biomechanical Phenomena↗

PubMedDate not supplied

[Case report of Ito-syndrome associated with congenital hemihypertrophy from the orthopaedic point of view].

We report on the orthopaedic treatment of a patient with the very rare Ito syndrome and congenital hemihypertrophy. The leading symptom is the lamellar depigmentation of the skin for which it is synonymously called incontinantia pigmenti acromians. Further anomalies are found in the central nervous system, as well as the ocular and the musculoskeletal systems. The treatment of the hemihypertrophy and the coexistent dysplasia of the hip with a combination of intertrochanteric shortening osteotomy and a triple osteotomy are specified and further methods are discussed.

Child↗

PubMed2005

Antimicrobial safety: focus on fluoroquinolones.

BACKGROUND/PURPOSE: Infrequent toxicities associated with certain drugs and drug classes have recently gained much attention from different health-care perspectives. To protect the patient, continued surveillance of safety and tolerability data is essential. Data from preclinical testing, phase 1-3 trials, and postmarketing surveillance may be used to objectively assess the risks associated with a specific drug or family of compounds. This review summarizes safety and tolerability data for the quinolones. MAIN FINDINGS: The most common adverse events associated with the quinolone class involve the gastrointestinal tract (nausea and diarrhea) and central nervous system (CNS) (headache and dizziness). These adverse events are usually mild and do not require discontinuation of therapy. Uncommon and potentially serious quinolone-related adverse events involve the cardiovascular system (rate-corrected electrocardiographic QT interval prolongation), musculoskeletal system (tendinitis and tendon rupture), endocrine system (glucose homeostasis dysregulation), renal system (crystalluria, interstitial nephritis, and acute renal failure), and the CNS (seizures). Severe idiosyncratic adverse events are specific to individual agents that may share some structural congruity, such as the 1-(2,4)-difluorophenyl group shared by trovafloxacin (associated with hepatitis), temafloxacin (associated with hemolytic-uremic syndrome), and tosufloxacin (associated with eosinophilic pneumonitis). Overall, discontinuation rates from clinical trials were <4% for the currently marketed quinolones. Quinolones with higher discontinuation rates, such as trovafloxacin (7.0%) and grepafloxacin (6.4%), are no longer available for general use. CONCLUSIONS: The currently marketed quinolones are well tolerated, with safety profiles similar to those of other antimicrobial classes. Although adverse effects are unusual, some, including tendinitis and CNS-related effects, are more common with quinolones than with other antimicrobial classes. Rare adverse effects attributed to some members of the quinolone family (e.g., Torsades de Pointes, hepatotoxicity, and dysglycemias) are more likely to occur in select "susceptible" populations. These adverse events can often be circumvented by avoiding exposure to the specific quinolone. In some cases, the therapeutic value offered by a quinolone may outweigh its potential risks.

Adult↗

PubMed2005

Musculoskeletal causes of chronic pelvic pain: a systematic review of existing therapies: part II.

UNLABELLED: Chronic pelvic pain is a common clinical problem with many causes. In addition to gynecologic causes, it is important to evaluate other potential etiologies, including the pelvic musculoskeletal system. There have been few published studies on musculoskeletal causes of pelvic pain and its treatment. The objective of this study was to evaluate treatment of pelvic musculoskeletal pain among women with chronic pelvic pain. We used a set of key words pertaining to pain and the pelvic musculoskeletal structures to initially review the PUBMED database. Additional articles were sought by discussion with a clinician specializing in this field and review of relevant textbook bibliographies. Study inclusion was restricted to English-language publications that reported a patient-related chronic pelvic pain outcome measure. Each report must have described at least four patients. For each selected article, two investigators separately summarized pertinent data on study characteristics, patient profiles, intervention characteristics, and treatment outcomes. Discrepancies were resolved by discussion. Twenty-nine treatment studies met entry criteria. The existing literature largely consists of retrospective, uncontrolled observational studies. The two studies that feature control groups lack sufficient size and scope to allow generalizability. Properly designed and executed randomized, controlled trials are urgently needed to determine the true effectiveness of treatments for pelvic musculoskeletal pain. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader should be able to summarize the current data on musculoskeletal causes of chronic pelvic pain, to outline the various techniques used to treat musculoskeletal causes of chronic pelvic pain, and to recall the lack of evidence based data on the subject and need for randomized controlled trials.

Adult↗

PubMed1992

Prevention and treatment of glucocorticoid-induced osteoporosis. A pathogenetic perspective.

Since the discovery of cortisol and the synthesis of related compounds, these potent pharmacologic agents have been progressively more widely utilized in allergic, pulmonary, and rheumatologic conditions. Organ transplantation represents a new group of patients added to the already large pool of subjects receiving glucocorticoids. However, glucocorticoids cause major side effects involving several organ systems, including the cardiovascular, endocrine, gastrointestinal, ophthalmologic, and musculoskeletal systems. Among the most dramatic side effects is the development of glucocorticoid-induced osteoporosis. Glucocorticoid use in the treatment of chronic obstructive pulmonary disease accounts for the majority of male patients with osteoporosis seen in our mineral metabolism clinic. This article focuses on glucocorticoid-induced osteoporosis in the adult with an emphasis on the clinical aspects of this condition. It is intended not as an extensive review on the subject but as a practical guide to help clinicians prevent and treat this condition in adult patients.

Bone Remodeling↗

PubMed1999

[A child of microscopic polyarteritis nodosa effectively treated with intravenous methylprednisolone pulses and serial cyclophosphamide pulse therapy].

Microscopic polyarteritis nodosa (mPAN) is a rare disorder in pediatric field of systemic small vessel vasculitis, and affects skin and musculoskeletal system accompanied by progressive necrotizing glomerulonephritis. We described here a 15-year-old boy with positive anti-neutrophil cytoplasmic antibody (MPO-ANCA) and severe mPAN, who was effectively treated with intravenous methylprednisolone pulse therapy followed by monthly cyclophosphamide pulses for 1 year. The histologic examination of renal biopsy specimen showed a severely desolated disease characterized by fibrinoid necrosis, crescent formation of most glomeruli and interstitial infiltration of inflammatory cells. The elevated titers of MPO-ANCA were useful markers for diagnosis, and the serial determinations of the antibody titers were indicative of disease activity. Moreover, dramatic clinical improvement after the induction of the combinatorial therapy and the disappearance of MPO-ANCA was correlated in the disease course. In this report, the serial determination of MPO-ANCA constituted a useful diagnostic tool and a sensitive marker of disease activity.

Adolescent↗

PubMed1992

Radiology rounds: MRI of rotator cuff arthropathy.

Magnetic resonance imaging (MRI) has proved to be an excellent diagnostic tool in evaluating the musculoskeletal system. This article illustrates one particular facet of musculoskeletal MRI: investigation of the rotator cuff tendon complex.

Humans↗

PubMed1990

Magnetic resonance imaging of pediatric atraumatic musculoskeletal lesions.

MRI has become a useful study for evaluating the musculoskeletal system. This article discusses the technique of pediatric musculoskeletal MRI and its practical applications. MRI appearances of various pathologic entities, including infection, neoplasms, marrow disorders, and joint diseases, are also reviewed.

Bone Diseases↗

PubMed1994

Congenital malformations at birth.

Three thousand nine hundred and thirty-two consecutive newborns were examined at birth for the presence of congenital malformations. The overall incidence of malformations was 1.2%. Congenital malformations accounted for 9.2% of perinatal and 12.8% of neonatal deaths. The central nervous system (39.5%) was most commonly involved followed by musculoskeletal system (14.5%). Involvement of more than one system was observed in 18.8% cases. Though there was higher incidence of malformations in babies born to mothers of more than 35 years the difference was not statistically significant. However, the babies born to mothers of gravidity 4 or more had significantly higher incidence of malformation when compared to mothers of lower gravidity (chi1(2) = 4.67, p < 0.05). The incidence of congenital malformations at birth was higher in stillborn and low birthweight babies.

Abnormalities, Multiple↗

PubMed1997

Blunt trauma and operative care in microgravity: a review of microgravity physiology and surgical investigations with implications for critical care and operative treatment in space.

BACKGROUND: The assembly of the International Space Station in a low earth orbit will soon become a reality. The National Aeronautics and Space Administration envisions inhabited lunar bases and staffed missions to Mars in the future. Increasing numbers of astronauts, construction of high-mass structures, increased extra-vehicular activity, and prolonged if not prohibitive medical evacuation times to earth underscore the need to address requirements for trauma care in nonterrestrial environments. STUDY DESIGN: A search was carried out to review the relevant literature in the MEDLINE and SPACELINE databases. All related Technical, Corporate, and Flight Test Reports in the KRUG Life Sciences corporate library were also reviewed. Bibliographies of all articles were then reviewed from these papers to identify additional pertinent literature. Senior Russian investigators reviewed the Russian literature and translated Russian publications when appropriate. Personal communication and discussion with active microgravity investigators and ongoing microgravity research supplemented published reports. RESULTS: A large volume of data exist to document the multiple detrimental physiologic effects of microgravity exposure on human physiology. Organs systems such as cardiovascular, neurohumoral, immune, hematopoetic, and musculoskeletal systems may be particularly affected. These physiologic changes suggest an impaired ability to withstand major systemic trauma. Observational data also suggest adverse changes in numerous aspects of response to wounding and injury, and in areas such as the behavior of hemorrhage, microbiologic flora, and wound healing. In addition to an increased volume of ongoing and anticipated basic science research in microgravity physiology, preliminary studies of clinical diagnosis and therapy have been carried out in microgravity and microgravity laboratories. The feasibility of a wide range of ancillary critical care techniques has been verified in the parabolic flight model of microgravity. Although Russian investigators first performed laparotomies on rabbits in parabolic flight in 1967, only recently have American investigators demonstrated the reproducible feasibility of open and endoscopic surgical procedures under general anesthetic in animal models in a microgravity environment. CONCLUSIONS: With appropriate instrumentation and personnel, the majority of resuscitative and surgical interventions required to stabilize a severely injured astronaut are feasible in a microgravity environment. Onboard limitations in mass, volume, and power that are ever present in any spacecraft design will limit the realistic capabilities of the medical system. Standard proved and tested trauma and operative management protocols will constitute the basis for extra-terrestrial care. Surgeons should familiarize themselves with the microgravity environment and remain active in planning trauma care for the continued exploration of space.

Aerospace Medicine↗

PubMedDate not supplied

Epidemiologic health study of workers in an aluminum smelter in Kitimat, B.C. II. Effects on musculoskeletal and other systems.

A health study was carried out on 2066 workers in an aluminum smelter in Kitimat, British Columbia to study the effects of exposure to fluoride and other air contaminants encountered on the potlines on the musculoskeletal system, hemopoietic tissue, liver, and renal function. Three hundred seventy-two railway repair workers from Squamish, British Columbia served as an "external" control group. Examination of the spine and sacroiliac joints and pelvic X-ray were conducted on long-term potline workers and a number of "internal" control workers in the smelter not exposed to any air contaminants. Urinary fluoride measurements and personal sampling for airborne fluoride were also carried out. Blood samples were collected for routine blood count and liver and renal function test. Definite cases of skeletal fluorosis were not found in any potroom workers. Some of the changes of early skeletal fluorosis described on pelvic X-rays, e.g., increased density, calcification of ligaments, and periosteal changes, were found in a few workers who were employed on the potlines for more than 10 yr. There was, however, poor agreement in the findings of the two radiologists who read the films. The entity "musculoskeletal fluorosis" does not exist in this smelter where the potroom workers were exposed to total fluoride levels below the currently accepted threshold limit value of 2.5 mg/m3. No ill effects on the hematopoietic tissue or liver and renal function were found.

Air Pollutants↗

PubMed2002

Interactions between muscle and the immune system during modified musculoskeletal loading.

Interactions between the immune system and skeletal muscle may play a significant role in modulating the course of muscle injury and repair after modified musculoskeletal loading. Current evidence indicates that activation of the complement system is an early event during modified loading, which then leads to inflammatory cell invasion. However, the functions of those inflammatory cells are complex and they seem to be capable of promoting additional injury and repair. Recent findings implicate an early invading neutrophil population in increasing muscle damage that is detected by the presence of muscle membrane lesions. Macrophages that invade subsequently serve to remove cellular debris, and seem to promote repair. However, macrophages also have the ability to increase damage in muscle in which there is an impaired capacity to generate nitric oxide. In vivo and in vitro evidence indicates that muscle-derived nitric oxide can serve an important role in protecting muscle from membrane damage by invading inflammatory cells. Collectively, these findings indicate that the dynamic balance between inflammatory cells, the complement system, and muscle-derived free radicals can play important roles in the secondary damage of muscle during modified musculoskeletal loading.

Animals↗

PubMed1996

High-level athlete's impressions of their preparticipation sports examination.

OBJECTIVE: To document the high-level athletes' impressions of their preparticipation examination (PE). EXPERIMENTAL DESIGN: Prospective study by self-reporting questionnaire. SETTING AND PARTICIPANTS: One hundred-fifty French athletes, involved in national or international-level events (PE is obligatory every year in France). Response rate obtained was 71%. Subject population consisted of 107 normal, healthy, elite athletes, ranging in age from 16 to 31 years (mean 22.4 years), included 69 males and 38 females. MEASURES: Knowledge and impression of PE, based upon the athletes' own experience. All of the consulted physician were trained and qualified in sports medicine. RESULTS: Thirty-six percent of the athletes reported having had bad-quality preparticipation sports visit (no significant difference between gender or age). According to them, medical history taking was "poor", and physical examination "restricted to blood pressure measurement" and/or "chest listening" and "not targeted enough on past athletic injuries". Athletes said PE should especially evaluate the cardiovascular system (75% of all citations to the item), the musculoskeletal system (16%) and the lungs (8%), and should involve an electrocardiogram (41%). CONCLUSIONS: Challenges for the future: 1) better educate physician in sport, to improve the preventive aspects of sports medicine 2) physicians should provide information to coaches and athletes concerning the optimal balance between health and physical performance, and therefore to the interest of PE.

Adolescent↗

PubMed2002

Gemcitabine-induced radiation recall.

PURPOSE: To study and report 6 patients with radiation recall in unique sites, secondary to gemcitabine chemotherapy. METHODS AND MATERIALS: The clinical presentations and outcomes of 6 patients with radiation recall secondary to gemcitabine chemotherapy were retrospectively analyzed over the course of a 1-year period. RESULTS: Radiation recall reactions were seen in the central nervous system, skin, gastrointestinal tract, and in the lymphatic and musculoskeletal systems. The time between initiation of radiation and recall of the radiation phenomenon ranged from 3 weeks to 8 months from the time gemcitabine was initiated. The usual dosage of gemcitabine in these cases was 1000 mg/m(2) given on a weekly basis. No radiation therapy was given concomitantly with gemcitabine. Treatment of the recall reaction consisted of discontinuing gemcitabine and initiating steroid therapy, supportive therapy, and/or nonsteroidal anti-inflammatory agents. Minimal improvement was seen in 3 out of 6 patients, and resolution of the radiation recall was seen in 3 out of 6 patients. A comprehensive review of the literature revealed that radiation recall with gemcitabine has been related to skin reactions only; no previous cases of radiation recall occurring in the central nervous system have been reported with any chemotherapy agent. CONCLUSION: Radiation recall from gemcitabine chemotherapy is rare, but can potentially arise in any site that has been previously irradiated. Treating physicians must be aware of this potential toxicity from gemcitabine and radiation and discontinue the gemcitabine if radiation recall is observed.

Adult↗

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↗

PubMed1996

Myopathy in primary systemic amyloidosis.

OBJECTIVE: To define the natural history of primary systemic amyloidosis when muscle involvement is prominent at presentation. METHODS: A retrospective review was carried out of all patients seen at the tertiary referral practice of the Mayo Clinic between 1 January 1960 and 31 December 1994. All patients with primary systemic amyloidosis and proof of amyloid deposits by muscle biopsy were included for analysis. No patients were lost to follow up. RESULTS: Twelve patients were identified with amyloidosis in muscle. Muscle involvement was the most prominent symptom in patients who had widespread visceral involvement, which included the heart, peripheral nerve, and tongue. Of the 12, three had skeletal muscle pseudohypertrophy. All patients had a demonstrable dysproteinaemia by the finding of free light chain in the serum or urine, a discrete monoclonal peak on serum or urine protein electrophoresis, or a monoclonal population of plasma cells in the bone marrow. Measurement of creatine kinase was not a useful test. Of eight patients treated with chemotherapy based on alkylating agents, three responded. The median survival for the entire group was 12 months. CONCLUSIONS: The finding of a monoclonal protein in a patient with muscle weakness is an important clue to the diagnosis of primary systemic amyloidosis. Most patients have visceral involvement outside the musculoskeletal system. A subset of patients seems to respond to systemic chemotherapy. The overall survival, however, remains poor, with most patients dying of cardiac failure. Immunoelectrophoresis of serum and urine should be a routine diagnostic test during the evaluation of myopathy of unknown cause.

Aged↗