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The authors present characteristics of working conditions and pathology associated with them: otorhinolaryngological damages, lesions of internals, nervous and musculoskeletal system. Engineering-technical, sanitary-hygienic, therapeutic and prophylactic measures intended for stopping occupational pathology at the early stages of its progress are recommended.
The paper discusses the problems of diagnostics and cause-effect relationship between the musculoskeletal system diseases and work performance of dentists; the study being based on available literature and own experimental studies. The findings indicate a need for further analysis in this respect.
The goal of this study was to evaluate the recognition rate, learning potential and amount of time needed to complete a report with the Philips speech recognition system SP 6000 (Philips, Best, The Netherlands). Four radiologists dictated reports of interventional radiology, MRI examinations of the musculoskeletal system and CT examinations of the thorax and abdomen with the Philips system using the German language. The recognition rate of each report and improvement rate after each learning phase of the Philips system was assessed. The time needed to complete a report using the Philips system was then compared with the time needed to complete a report using the tape-based system via a time analysis. The average recognition rate for the four radiologists using the Philips system was 79.6 %, which improved to 92.5 % after the third adaptation. Initially, the average time demand to dictate and correct one report was approximately 16.8 min, but this time decreased to 8.1 min after the third adaptation. In contrast, only 3. 6 min were needed to dictate and correct one report using the tape-based system. However, with the speech recognition system, dictation, correction and transcription of the report can be completed within 15 min, whereas with the tape-based system, it takes nearly 1 day. With the Philips system, speech recognition can reach as high as 95 % since each adaptation of the system improves the recognition rate by approximately 5 %. While the Philips system is associated with longer dictation times than the tape-based system, turn-around time for a complete report is substantially shorter with the Philips system than the tape-based system.
In the last 2 decades, there has been a dramatic change in the clinical approach to the tumors of the musculoskeletal system. The role of medical imaging in diagnosis, staging,and eventual follow-up of patients who have musculoskeletal neoplasia has expanded. This article presents an overview of the role of imaging, recent advances in technology,and state-of-the-art techniques for evaluating musculoskeletal neoplasms. Conventional imaging modalities, ultrasound, CT, MRI, positron emission tomography, and image-guided interventions are discussed.
Lyme borreliosis (Lyme disease) is a systemic infectious disease with a wide spectrum of symptoms affecting the skin, the heart, and the nervous and musculoskeletal systems. Lyme borreliosis is caused by the spirochaete Borrelia burgdorferi and transmitted by ticks. The disease occurs in endemic pockets with an incidence of from 50 to more than 100 cases per 100,000 inhabitants. Despite increasing knowledge about the virulence factors of the spirochaetes and the immune response of the host, many aspects of the pathogenesis, for example of chronic treatment-resistant disease, are still a matter of debate. The diagnosis is based on clinical findings and confirmed by serology. Diagnostic problems arise from patients with non-specific symptoms and a positive IgG serology. In about 80% of the patients, the disease can be cured by adequate antibiotic therapy. Evidence-based guidelines for treatment have been recently published. The only vaccine to prevent Lyme disease, licensed in the USA, has been discontinued due to disappointing sales despite good efficacy and tolerability.
OBJECTIVE: To study the relationship between reported chronic pain and the level of serum urate (SU) among women with various diagnoses of the musculoskeletal system. METHODS: Consecutive female patients (aged 20-70 years, n = 124), at rheumatology and rehabilitation practices, with chronic musculoskeletal pain of different origins were followed for 1 year after an initial survey of pain, lifestyle, quality of life, and disability. Repeated blood samples (including urate, creatinine, cholesterol, and glucose) were analysed. Multiple regression analysis was performed to explain initial variations in SU level in relation to pain and confounding factors. RESULTS: The level of SU was increased among individuals with widespread pain (>5 locations) independent of underlying diagnoses compared to those with fewer pain sites (270.5 vs. 241.2 micromol/L). Serum creatinine, body mass index (BMI), the number of pain locations, and sleep disturbances independently contributed to the SU level and explained 43% of the variation in SU. Individual variation in SU during 4 months was low. CONCLUSIONS: Epidemiological data on the relationship between the extent of body pain and SU were confirmed in a clinical setting. Besides known factors such as impaired renal function and obesity, widespread pain and sleep disturbances were related to an increase in SU. Medication and alcohol intake could not explain the findings. Longitudinal studies are necessary to elucidate whether the level of SU has any implications for the prognosis of chronic pain.
Once naive T cells encounter antigen, they become primed effector cells. The scope of effector functions mediated by these cells defines the efferent arm of the immune response. The change from naive to primed effector cell is known as adaptive immunity and takes 2 forms: cell mediated, in which T cells mediate effector function, and humoral, in which antibodies are the effector molecules. There are 3 types of effector T cells: inflammatory CD4 T cells, which activate macrophages; helper CD4 T cells, which help B lymphocytes produce antibody; and cytotoxic CD8 T cells, which kill their target cells. The interaction of primed effector cells with their targets results in phenotypic changes in the cells and the secretion of cytokines. These cytokines may be secreted by the primed effector T cell, the target cell, or both. Cytokines function in either autocrine (secreted and used by the same cell) or paracrine (secreted by 1 cell and used by a different cell) circuits and have marked regulatory effects on cells in both the immune and skeletal systems. Many of these cytokines, which were once thought to be products exclusively of immune cells, are now known to be produced by cells of the skeletal system. Both the specific and nonspecific components of the immune response have profound effects on remodeling of the musculoskeletal system during normal and pathologic states.
During a four-year period, twenty-one patients were found to have melioidosis of the musculoskeletal system caused by Pseudomonas pseudomallei. The melioidotic patients were matched with thirty-nine patients who had a musculoskeletal infection due to some other organism, and the two groups were compared with regard to the presence of concurrent disease. The indirect hemagglutination test for melioidosis was positive for all of the melioidotic patients; in thirteen, cultures also were positive. For the patients who did not have melioidosis, the diagnosis was made on the basis of positive cultures of other organisms or histological sections. In most of the non-melioidotic patients, the infection was due to Staphylococcus aureus (twenty-four patients) or to Mycobacterium tuberculosis (twelve patients). The most common concurrent diseases in the melioidotic patients were diabetes and thalassemia. The odds that melioidosis was the cause of the infection in a patient who had a concurrent disease were twelve to one. All melioidotic patients were managed with operative débridement and a combination of drugs--usually, trimethoprim and sulfamethoxazole, doxycycline, and kanamycin or chloramphenicol--for six months. The mean duration of follow-up was one and one-half years. Of the twenty-one patients, eighteen had an excellent or good result in terms of motion of the joint and absence of relapse.
The purpose of this study was to review the published evidence of the effects of cystic fibrosis (CF) on the musculoskeletal system, and their implications on the quality of life of these patients. With increasing longevity of CF patients, musculoskeletal manifestations have become important. Decreased bone mineral density (BMD) and bone mineral content (BMC) are common at all ages in CF patients, and its cause is probably multifactorial. Risk factors contributing to decreased BMC include age of the patient, imbalance between bone accretion and degradation, body mass, nutrition, activity, exposure to glucocorticoid therapy, and gonadal dysfunction. BMC correlates strongly to fat-free mass in CF patients. Lung transplant, while increasing life span, can worsen osteoporosis. Twenty-nine percent of patients are below the 10th percentile for height. Fracture rates are approximately twofold greater in females aged 16 to 32 years and males aged 25 to 34 years. Female patients aged 6 to 16 have a higher than normal fracture rate and a higher rate than their male counterparts. Spinal consequences of osteoporosis include excessive kyphosis in up to 62% of patients. Back pain was noted in 94% of patients. Arthritis in CF, although less common, can be very incapacitating, and it is mainly of three types: CF arthritis, hypertrophic osteoarthropathy, and arthritis due to co-existent conditions and drug reactions. The treatment of arthritis is mainly symptomatic in the majority of cases.
The aim of the review is to determine complex relations between obesity and disability. Obesity is defined as an abnormal, pathologic increase in body fat. This disease results from environmental factors, like: low level of physical activity, excessive intake of high energy food and genetic predisposition to storage of fat. The health consequences of obesity are chronic diseases: diabetes mellitus type 2, dyslipidemia, coronary heart disease, gallbladder disease, osteoarthritis, sleep apnea, certain types of cancers and also psychosocial problems, which together have an adverse effect on quality of life. The consequences of this comorbidities and conditions are also higher rates of disability in this group of people. Limitations in everyday functioning of the overweight and obese people are the consequence of comorbidities, for example: diseases of the circulatory system and late diabetic complications. The leading cause of disability (especially in functional area) is impairement of the musculoskeletal system, caused by excessive weight, for ex. chronic back pain. In this case the mechanism of "vicious cycle" is observed where sedentary lifestyle contributes to obesity and obesity exacerbates disability. The role of physical inactivity in the development of weight gain emphasises the fact that among people with disabling conditions rates of obesity are significantly higher.
There is a broad range of clinical applications for MRI in the diagnosis of musculoskeletal disease, and the emphasis in this article is on the evaluation of the joints and extremities. A discussion of basic principles, including radiofrequency coils, positioning, pulsing sequences, imaging planes, and technical parameters is followed by discussions of tailored approaches to the evaluation of mass lesions and joint pathology for specific regions of the musculoskeletal system. In the final section, consideration is given to the overall role of MRI in the diagnosis of musculoskeletal disorders with respect to other established imaging modalities.
Evaluation of the compressive load acting on the lumbar spine (L3-L4) during half-squat exercises executed with a barbell resting on the subject's shoulders was undertaken. The kinematics of the upper body segments of two male and two female subjects as well as the barbell were described using data obtained by means of an optoelectronic system (CoSTEL). L3-L4 compressive load was calculated using a model of the anatomy of the trunk musculoskeletal system. Filtered surface electromyographic trunk flexor recordings from the obliquus externus and rectus abdominis and trunk extensor erectores spinae muscles as well as measurement of the ground reaction forces were also carried out for predicted result validation. During half-squat exercises with barbell loads in the range 0.8 to 1.6 times body weight the compressive loads on the L3-L4 segment vary between 6 and 10 times body weight. Erectores spinae contraction force was predicted to be between 30 and 50% of the relevant maximal isometric force. The magnitude of trunk flexion was found to be the variable which influenced most spinal compression load.
Magnetic resonance imaging (MRI) allows the non-invasive obtention of diagnostic images, with no ionizing radiation emission and in any space plane. It has a great capacity to differentiate anatomic structures, and it is very useful for planning surgery or radiotherapy. It is the first choice diagnostic technique in conditions involving the central nervous system, useful for establishing diagnosis, surgery planning, and following lesions involving the spinal cord and spine. In the musculoskeletal system it may become and appropriate alternative to arthroscopy. Nevertheless, it is of limited use for the diagnosis of chest, abdominal and pelvic pathology.
The probability of recording infectious diseases and injuries to the musculoskeletal system during sports events with a large number of participants is very high. From an historical perspective the distribution and trends of diseases that have an impact on public health have been evaluated by means of epidemiological surveillance systems. However, the application of these epidemiological methods to sports medicine is relatively recent. The utilization of an epidemiological surveillance system during sports events with a large number of participating athletes and countries has been reported in a limited number of competitions. In this article we describe the design of a system for epidemiological surveillance utilized during the XVII Central American and Caribbean Sports Games held in Puerto Rico in 1993, as an example of a surveillance system that could be regularly established in this type of event.
A review of over 100 articles and our own experience of scanning nearly 500 children with magnetic resonance (MR) imaging indicate that MR is well tolerated by children. Magnetic resonance is already proving to be the imaging modality of choice for the central nervous system. It should soon prove its utility for the study of most tumors, vascular problems, and infections of the musculoskeletal system. In other regions of the body, MR can identify abnormality well, but many of these abnormalities can be identified well with other modalities, and the precise role of MR is yet to be defined. We anticipate that the number of indications for the use of MR will grow rapidly.
Increasing numbers of children are becoming involved in competitive sport. International trends in pre-adolescent sports participation are mirrored in New Zealand, where promising young athletes are being exposed to high-intensity training from an earlier age. As a consequence, overuse injuries which were traditionally described in more mature athletes are now becoming recognized in pre-adolescents. The immature musculoskeletal system is less able to cope with repetitive biomechanical stress. Sites of overuse injury reflect the sites of rapid musculoskeletal development. It therefore behoves all medical practitioners, but particularly those in primary care, to be aware of the young athlete at risk. Inherent in the presentation of such musculoskeletal insult there often lurks an over-enthusiastic parent. We are all well reminded of the covert pressures adults may bring to bear upon children. Psychological, as well as physical injury often results.
The association of relative weight with various indices of musculoskeletal morbidity was studied in 902 Finnish white-collar and blue-collar workers. Data were collected in the years 1973 and 1983 through a postal questionnaire, by medical examination, and clinical assessment of the condition of the musculoskeletal system. In the overweight group (relative weight greater than or equal to 120 percent), higher mean levels in all musculoskeletal scores (the Musculoskeletal Symptoms Score, the Upper/Lower Extremities Score, the Low Back Score and the Musculoskeletal Findings Score) were observed, compared with the normal weight group. There was no evidence, however of rheumatic complaints in weight-bearing joints being more common in overweight individuals, contrary to the 'wear and tear' hypothesis. In a 10-year follow-up the changes in the musculoskeletal scores were analysed by stepwise multiple regression. Baseline relative weight explained 6.3 percent of the variation in the score based on clinical assessment. Neither baseline weight nor weight change were significant predictors of change in the other scores. No association was observed between overweight and lumbosacral disorders either in the cross-sectional study or in the 10-year follow-up.
A comparative study of patients attending general practitioner and consultant day hospitals for the elderly in Clwyd is described. The general characteristics of both patient groups were similar. There were, however, differences in the types of illness represented: disorders of the nervous system, mainly strokes, comprised over one third (37 per cent) of the consultant day hospital cases; disorders of the musculoskeletal system, mainly osteoarthrosis, comprised nearly one third (29 per cent) of the general practitioner group. Over 70 per cent of patients attending both types of day hospital had been discharged within six months and most attended once or twice each week. Clinical evaluation on discharge showed that over 80 per cent of the patients in both types of hospital had shown improvement or had not further deteriorated during their period of attendance.It is concluded that day hospital care in community hospitals, supervised by general practitioners, can make an effective contribution to total health care provision for the elderly.