Quinolone Ear Drops and Achilles Tendon Rupture.

BACKGROUND: Delayed eardrum healing has been observed in the ear opposite to the ear treated with otic quinolones (OQ) in rats. Case reports describe tendinopathies after OQ treatment, suggesting adverse systemic effects. METHODS: We studied patients aged 19 to 64 years with diagnosis of otitis externa or media in private insurance between 2005 and 2015. We compared OQ treatment against otic neomycin, oral amoxicillin, or azithromycin. Outcomes included Achilles tendon rupture (ATR), Achilles tendinitis (AT), and all-type tendon rupture (ATTR). We applied an active comparator, new-user design with 1-year look-back and ceased follow-up at initiation of systemic steroids or oral quinolones, external injury, hospitalization, and after 35 days. We used trimmed stabilized inverse probability of treatment weights to balance comparison groups in a survival framework. Negative outcomes (clavicle fractures or sports injuries) were examined to rule out differences from varied physical activity (unmeasured confounding). RESULTS: We examined 1 501 009 treated otitis episodes. Hazard ratios (HR) for OQ exposure associated with ATR were 4.49 (95% confidence interval [CI], 1.83-11.02), AT 1.04 (95% CI, 0.73-1.50), and ATTR 1.71 (95% CI, 1.21-2.41). Weighted risk differences (RD) per 100 000 episodes for OQ exposure were ATR 7.80 (95% CI, 0.72-14.89), AT 1.01 (95% CI, -12.80 to 14.81), and ATTR 18.57 (95% CI, 3.60-33.53). Corresponding HRs for clavicle fractures and sports injuries were HR,1.71 (95% CI, 0.55-5.27) and HR,1.45 (95% CI, 0.64-3.30), suggesting limited residual confounding. CONCLUSIONS: OQ exposure may lead to systemic consequences. Clinicians should consider this potential risk and counsel patients accordingly. Risk factors and mechanisms for this rare, adverse effect deserve further evaluation. Mechanistic and other clinical studies are warranted to corroborate this finding.

A curious case of stress fracture in a transsexual athlete.

Femoral neck stress fractures in young healthy individuals are rare and occur in those who take part in physical training with repetitive loading and those with osteoporosis. Bone density is related to sex hormone status, which is artificially manipulated during gender reassignment. Conflicting evidence currently exists on the effect of cross sex hormone treatment on bone density, with no literature suggesting a link between hormone treatment in gender reassignment and stress fractures. Our aim is to highlight the potential risk of stress fractures amongst transsexual patients receiving cross sex hormones as part of gender reassignment. The patient presented with groin pain after competing in a running event. Despite a number of risk factors, there was a delay in diagnosis, which could have led to complications compromising outcome. Femoral neck stress fractures should be considered in the differential diagnosis of transsexual patients receiving hormone treatment with non-specific groin/thigh pain following exercise.

Fluoroquinolones and tendinopathy: a guide for athletes and sports clinicians and a systematic review of the literature.

CONTEXT: Fluoroquinolone antibiotics have been used for several decades and are effective antimicrobials. Despite their usefulness as antibiotics, a growing body of evidence has accumulated in the peer-reviewed literature that shows fluoroquinolones can cause pathologic lesions in tendon tissue (tendinopathy). These adverse effects can occur within hours of commencing treatment and months after discontinuing the use of these drugs. In some cases, fluoroquinolone usage can lead to complete rupture of the tendon and substantial subsequent disability. OBJECTIVE: To discuss the cause, pharmacology, symptoms, and epidemiology of fluoroquinolone-associated tendinopathy and to discuss the clinical implications with respect to athletes and their subsequent physiotherapy. DATA SOURCES: We searched MEDLINE, Cumulative Index to Nursing and Allied Health (CINAHL), Allied and Complementary Medicine Database (AMED), and SPORTDiscus databases for available reports of fluoroquinolone-related tendinopathy (tendinitis, tendon pain, or rupture) published from 1966 to 2012. Search terms were fluoroquinolones or quinolones and tendinopathy, adverse effects, and tendon rupture. Included studies were written in or translated into English. Non-English-language and non-English translations of abstracts from reports were not included (n = 1). STUDY SELECTION: Eligible studies were any available reports of fluoroquinolone-related tendinopathy (tendinitis, tendon pain, or rupture). Both animal and human histologic studies were included. Any papers not focusing on the tendon-related side effects of fluoroquinolones were excluded (n = 71). DATA EXTRACTION: Data collected included any cases of fluoroquinolone-related tendinopathy, the particular tendon affected, type of fluoroquinolone, dosage, and concomitant risk factors. Any data outlining the adverse histologic effects of fluoroquinolones also were collected. DATA SYNTHESIS: A total of 175 papers, including 89 case reports and 8 literature reviews, were identified. CONCLUSIONS: Fluoroquinolone tendinopathy may not respond well to the current popular eccentric training regimes and may require an alternative, staged treatment approach. Clinicians, athletes, athletic trainers, and their medical support teams should be aware of the need to discuss and possibly discontinue these antibiotics if adverse effects arise.

[Fluorquinolone associated tendon rupture]. / Achillessehnenruptur unter Fluorochinolonen.

We report the case of a 38-year-old patient with a rupture of the right Achilles tendon after physical exercise. A few days before he had been treated with ciprofloxacine 500mg bid for chlamydial urethritis. We discuss know risk factors for Achilles tendon ruptures and the possible contribution of ciprofloxacin and fluorquinolones in this case.

Bassini's hernial repair and adductor longus tenotomy in the treatment of chronic groin pain in athletes.

A prospective study was initiated to evaluate the surgical treatment of chronic groin pain resistant to conservative treatment. Forty-one patients were treated using Bassini's hernial repair and percutaneous adductor longus tenotomy between 1984 and 1998. All patients were males aged 17 to 34 years and were mainly soccer players. Twenty-seven patients underwent a unilateral and 14 a bilateral procedure. All patients had resumed their sporting activities on average 6.9 months after surgery (range 6 to 15 months). Thirty-seven performed at the same level and 4 at a reduced level. Only one patient performed at a lower level due to persistent groin pain. We conclude that, when conservative treatment for pubic pain in athletes fails, a combination of hernial surgery and adductor longus tenotomy can provide successful results.

[Rupture of the Achilles tendon after local steroid injection. Case reports and consequences for treatment]. / Achillessehnenruptur nach lokaler Steroidinjektion. Kasuistik und Konsequenzen für die Behandlung.

It is known that Steroids increase the risk for tendon ruptures. Despite this local steroids are still used in the treatment of achilles tendinitis. Three cases are demonstrated. All of them show an unusual rupture mechanism. Intraoperatively necrotic tendon changes are seen. All patients receive an open tendon reconstruction with healthy, autologous material. Although there is a delayed healing in one case, all patients show favourable results one year postoperatively with return to full range activity levels and are able to participate in sports.

Lime burns in a professional football goalkeeper - an unusual hazard.

Burns due to lime, although well reported as a result of occupational exposure, are uncommon in the sports arena. A case of such a chemical burn, which required surgery in a football goalkeeper is presented. There are safe alternatives to line marking on football pitches the use of which will prevent such injuries and avoid litigation.

Ocular trauma resulting from the explosive rupture of a liquid center golf ball.

The likelihood of a patient seeking consultation with an ocular injury due to puncturing and subsequent explosive rupture of a golf ball seems remote. This very set of circumstances occurred at our V.A. Medical Center Optometry clinic. Golf ball manufacturers receive inquiries each year concerning the makeup of these liquid centers. Lack of current available information from ophthalmic journals or poison control centers prompted an inquiry into the exact nature of these golf balls. Further concern was for the measured alkalinity and extreme pressure exhibited by the liquid center golf ball brought in by the patient just after injury occurred. A case report is presented. Retrospective evaluation of previous literature is reviewed as well as information from golf ball manufacturers.