Disparities in Sports Medicine Health Care Access in Illinois High Schools: Access to Team Physicians, Athletic Trainers, and Automated External Defibrillators.

ABSTRACT: High school athletes have higher rates of injuries and sudden death than their college counterparts. Medical care for these athletes should include access to team physicians, athletic trainers, and automated external defibrillators. Disparities in medical care access provided by high schools for their athletes may be due to school characteristics or socioeconomic or racial factors. This study investigated relationships between these factors and access to team physicians, athletic trainers, and automated external defibrillators. Medical care access is negatively related to the percentage of low-income students and positively related to the number of sports offered. Relationships between race and access to a team physician became nonsignificant when the percentage of low-income students was considered. Physicians who treat high school athletes should consider the medical care access provided by their schools when they educate these patients about preventing and treating sports injuries.

What Protects Certain Nerves from Stretch Injury?

The human tibial nerves is less prone to injury following joint arthroplasty compared with the peroneal nerves. Besides the anatomical distribution, other features may confer protection from stretch injury. We therefore examined the size, shape and connective tissue distribution for the two nerves. The tibial and peroneal nerves from each side of nine fresh human cadavers we reharvested mid-thigh. Proximal segments manually stretched 20%-25% were fixed in aldehyde, while the adjacent distal segments were fixed in their natural length. Paraffin sections stained by Masson's trichrome method for connective tissue were examined by light microscopy. Tibial nerves had 2X more fascicles compared with the peroneal, but the axonal content appeared similar. Analysis showed that neither nerve had a significant reduction in cross sectional area of the fascicles following stretch. However, fascicles from stretched tibial nerves become significantly more oval compared with those from unstretched controls and peroneal nerves. Tibial nerves had a greater proportion that was extrafascicular tissue (50-55%) compared with peroneal nerves (38%-42%). This epineurium was typically adipose tissue. Perineurial thickness in both nerves was directly related to fascicular size. Tibial nerves have several unique histological features associated with size, shape and tissue composition compared with the peroneal nerve. We suggest that more fascicles with their tightly bound perineurium and more robust epineurium afford protection against stretch injury. Mechanical studies should clarify how size and shape contribute to nerve protection and/or neurapraxia.

Occurrence and recurrence of gastric dilatation with or without volvulus after incisional gastropexy.

This study investigated recurrence of gastric dilatation without (GD) or with volvulus (GDV) after incisional gastropexy (IG) in dogs that underwent IG for prevention of GDV. Signalment, concurrent surgical procedures, presence of GD or GDV at the time of IG were obtained from medical records of dogs that underwent IG. Owners were contacted to determine whether the dogs experienced GD or GDV after IG, dates of postoperative GD or GDV episodes, survival status, date of death for deceased dogs. Gastric dilatation and GDV recurrence rates were calculated for 40 dogs that had at least 2 y follow-up from the time when IG was performed and for dogs that experienced GD or GDV during the follow-up period. No dogs experienced GDV after IG and 2 dogs (5.0%) experienced GD after IG. The results suggest that GD and GDV rates after IG may be comparable to recurrence rates after other methods of gastropexy.

Occurrence et récurrence de la dilatation gastrique avec ou sans volvulus après une gastropexie incisionnelle. Cette étude a examiné la récurrence de la dilatation gastrique sans volvulus (DG) ou avec volvulus (DGV) après une gastropexie incisionnelle (GI) chez les chiens qui avaient subi une GI pour la prévention de la DGV. Le signalement, les interventions chirurgicales concomitantes, la présence de la DG ou de la DGV au moment de la GI ont été obtenus dans les dossiers médicaux de chiens qui ont subi une GI. On a contacté les propriétaires pour déterminer si les chiens avaient eu une DG ou une DGV après la GI, les dates des épisodes postopératoires de DG ou de DGV, l'état de la survie et la date de la mort pour les chiens décédés. Les taux de récurrence de la dilatation gastrique et de la DGV ont été calculés pour 40 chiens qui ont eu un suivi d'au moins 2 ans à partir de la réalisation de la GI et pour les chiens qui avaient eu une DG ou une DGV durant la période de suivi. Aucun chien n'a eu une DGV après une GI et 2 chiens (5,0 %) ont connu une DG après la GI. Les résultats suggèrent que les taux de DG et de DGV peuvent être comparables aux taux de récurrence après d'autres méthodes de gastropexie.(Traduit par Isabelle Vallières).

Thermal effusivity changes as a precursor to moist desquamation.

Skin toxicity is a ubiquitous side effect in radiotherapy and can be difficult to predict. Moist desquamation in cancer patients can decrease quality of life and occasionally demand unplanned treatment breaks thus worsening outcome. In breast cancer patients, moist desquamation occurs approximately one-third of the time, and while avenues such as intensity-modulated radiation therapy exist to decrease skin side effects, they may be prohibitively expensive to distribute widely. To selectively target patients who are at risk for high skin toxicity, toxicity prediction beyond heuristics is required. This study presents 3D thermal tomography, a translation technology that employs active thermal imaging to map the thermal effusivity of skin. Irradiated mice were imaged throughout reaction development to establish a correlation between effusivity changes and eventual toxicity severity. Female hairless mice (n = 11) were anesthetized and irradiated to 40 Gy in one fraction using a 1 cm Leipzig brachytherapy applicator with an Ir-192 source. After irradiation, thermal imaging was conducted daily with a flash lamp and infrared camera. Effusivity was calculated using custom software and tracked within irradiated and contralateral control regions. Mice were retrospectively grouped into high-grade (moist desquamation present, n = 6) and low-grade (n = 5). All mice showed an increase in the relative average effusivity difference among the treated and control regions between irradiation and peak reaction between 12 and 15 days after irradiation. The high-grade group showed an earlier increase in relative average effusivity difference (mean 1.7 days after irradiation versus 4.4 days after irradiation) than the low-grade group, and had a significantly greater relative average effusivity difference between 2-5 days after irradiation. We concluded that 3D thermal tomography is quick, non-invasive, non-ionizing and exhibited a correlative difference between mice that eventually developed moist desquamation and those that only presented dry desquamation. With further development, it may prove to be a useful tool in the clinic for differentiating patients who require preventative measures to reduce skin toxicity.

Comparison of topical anesthetics for intravitreal injections : a randomized clinical trial.

PURPOSE: To determine whether there is a difference in anesthetic effect between topical proparacaine drops, 4% lidocaine solution, or 3.5% lidocaine gel, and whether this has an impact on the overall injection experience. METHODS: One hundred and twenty sequential patients undergoing intravitreal injections were randomized to 1 of 3 groups: proparacaine 0.5% drops (Group 1), proparacaine + 4% lidocaine-soaked cotton tipped swabs (Group 2), or 3.5% lidocaine gel (Group 3). Discomfort associated with the lid speculum, with the needle, and with burning sensation was graded on a scale of 0 to 10 (0 = no pain, 10 = worst pain ever). The overall injection experience was graded as Excellent, Very Good, Fair, Poor, or Awful. RESULTS: The average lid speculum pain score for Group 1 was 0.85, Group 2 was 0.50, and Group 3 was 0.65 (P = 0.32). The average needle pain score for Group 1 was 1.78, Group 2 was 1.75, and Group 3 was 1.48 (P = 0.38). The average burning pain score for Group 1 was 1.45, Group 2 was 1.58, and Group 3 was 1.13 (P = 0.23). Overall satisfaction was rated as Excellent or Very Good in 95%, 97.5%, and 92.5% of Group 1, 2, and 3 patients, respectively (P = 0.64). CONCLUSION: The use of topical proparacaine drops provides very effective and cost-effective anesthesia during office-based intravitreal injections.

Surgical treatment of medial patellar luxation without femoral trochlear groove deepening procedures in dogs: 91 cases (1998-2009).

OBJECTIVE: To assess signalment, outcomes, and complications for dogs surgically treated for medial patellar luxation (MPL) with a combination of lateral retinacular imbrication and tibial crest transposition procedures without femoral trochlear groove deepening techniques, and to determine whether osteoarthritis progressed in these patients during the 8-week period following surgery. DESIGN: Retrospective case series. Animals-91 dogs. PROCEDURES: Medical records were reviewed for information on signalment, clinical history, unilateral versus bilateral disease, preoperative and postoperative MPL grades, duration of follow-up, and perioperative and postoperative complications. Radiographs obtained preoperatively and during 8-week follow-up examinations were reviewed and assigned degenerative joint disease (DJD) scores (range, 0 to 3). Data were analyzed to determine factors influencing outcomes. Kaplan-Meier curves were constructed for recurrence of MPL. RESULTS: Minor postoperative complications were reported for 31 of 91 (34.1%) dogs. Patellar reluxation occurred in 18 of 91 (19.8%) dogs. Reluxation or complications for which additional surgery was recommended developed in 6 of 91 (6.6%) dogs. At last clinical follow-up, 10 of 91 (11.0%) dogs had at least occasional lameness. No difference was revealed between preoperative and postoperative (8-week follow-up) radiographic DJD scores. CONCLUSIONS AND CLINICAL RELEVANCE: Results of surgical treatment of MPL without femoral trochlear groove deepening procedures were comparable to those in studies of surgical treatment that included groove deepening procedures. Radiographic indices of DJD did not increase during the 8 weeks following surgery. These results suggest that trochlear groove deepening procedures are not always necessary, and patients that undergo these techniques should be carefully selected.

Clinical characteristics affecting the outcome of pneumatic retinopexy.

OBJECTIVES: To review characteristics and outcomes of patients who underwent primary pneumatic retinopexy (PR) for repair of rhegmatogenous retinal detachment in a multioffice retina practice and to determine what preoperative characteristics were associated with success or failure of PR. METHODS: A retrospective medical record review was conducted of patients who underwent primary PR from September 2001 to March 2009. Patients with less than 6 months of follow-up were excluded. Data collected on each patient included age, sex, affected eye, preoperative visual acuity, lens status, presence of posterior vitreous detachment, presence of vitreous hemorrhage, macular status, presence of lattice degeneration, number and location of retinal breaks, clock hour extent of detachment, final visual acuity, final retinal status, number of procedures to reattach retina, and duration of follow-up. RESULTS: Two hundred thirteen patients were included. The mean age was 59.3 years and 53.5% were male. Mean follow-up was 24.6 months, and 64.8% of patients had a successful PR. Vitreous hemorrhage and retinal detachment greater than 4.5 clock hours were the 2 factors that significantly affected successful outcome (P = .04 and .01, respectively). The overall mean final visual acuity was 20/40, with a mean of 20/30 in the success group and a mean of 20/60 in the failure group (P < .001). CONCLUSIONS: Pneumatic retinopexy is a treatment option for certain types of rhegmatogenous retinal detachment. In patients with vitreous hemorrhage and detachments greater than 4.5 clock hours, the success rate may be lower. Final visual acuity is better with successful reattachment with a single procedure.

Vaginal mesh for prolapse: a randomized controlled trial.

OBJECTIVE: To present 3-month outcomes of a double-blind, multicenter randomized controlled trial comparing traditional vaginal prolapse surgery without mesh with vaginal surgery with mesh. METHODS: Women with pelvic organ prolapse quantification prolapse stages 2-4 were randomized to vaginal colpopexy repair with mesh or traditional vaginal colpopexy without mesh. The primary outcome measure was objective treatment success (pelvic organ prolapse quantification stage 1 or lower) at 3 months. Secondary outcome measures included quality-of-life variables and complication rates. RESULTS: Sixty-five women were recruited from January 2007 to August 2009, when the study was halted due to predetermined stopping criteria for vaginal mesh erosion at a median follow-up of 9.7 months (range, 2.4-26.7 months). Thirty-two women underwent mesh colpopexy (24 anterior mesh, eight total mesh), and 33 women had vaginal colpopexies without mesh (primarily uterosacral ligament suspension) and concurrent colporrhaphy. There were no statistically significant baseline differences between the mesh and no-mesh groups with respect to demographics, menopausal status, and race. Analysis of the mesh and no-mesh women found no difference with respect to overall recurrence (mesh: 19 [59.4%] compared with no mesh: 24 [70.4%], P=.28). There were five (15.6%) vaginal mesh erosions. Two cystotomies and one blood transfusion occurred in the mesh group only. Subjective cure of bulge symptoms was noted in 93.3% of mesh patients and 100% of no-mesh patients. Furthermore, subjective quality-of-life measurements did not differ between the two groups at baseline or 3 months postoperatively. CONCLUSION: At 3 months, there is a high vaginal mesh erosion rate (15.6%) with no difference in overall objective and subjective cure rates. This study questions the value of additive synthetic polypropylene mesh for vaginal prolapse repairs. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, www.clinicaltrials.gov, NCT00475540. LEVEL OF EVIDENCE: I.

Thumb carpometacarpal suspension arthroplasty using interference screw fixation: surgical technique and clinical results.

PURPOSE: Arthritis of the thumb carpometacarpal (CMC) joint is a common condition, for which reconstruction using the flexor carpi radialis (FCR) is a standard treatment. We describe the technique and clinical results for thumb CMC arthroplasty using interference screw fixation of the FCR to the first metacarpal through a single incision. METHODS: Over 12 months, 29 consecutive CMC arthroplasties were performed in 29 patients using FCR transfer tenotomized at the level of the scaphoid with an absorbable biotenodesis screw for fixation. There were 24 women and 5 men, with a mean age of 58 years. Patients were evaluated at a minimum of one year with radiographs, standardized outcome instruments, and measurements of motion and strength. The scaphoid to first metacarpal distance was measured at 2 weeks, 3 months, and greater than 1 year to assess settling. RESULTS: A total of 28 patients were available at a mean of 19 months. No arthroplasties required revision. Postoperative scaphoid to first metacarpal distance was 5.9 mm, which had decreased by a mean of 1.4 mm at final follow-up. There were no side-to-side differences in range of motion or strength in the entire cohort except for lateral key pinch, which was lower on the reconstructed side. The mean postoperative Disabilities of the Arm, Shoulder, and Hand score was 15, and the mean visual analog scale score was 1. Correlations were found between age and lateral key pinch strength for the reconstructed and contralateral sides. There were no significant relationships among Disabilities of the Arm, Shoulder, and Hand score, visual analog scale, radiographic settling, side-to-side strength or range of motion versus gender, Eaton stage, or workers' compensation status. CONCLUSIONS: Our series demonstrates excellent clinical outcomes with no revisions at an average of 19 months for this technique. Strength, range of motion, and radiographic settling compare favorably with published results of alternative techniques. Except for lateral key pinch, there was no statistically significant difference in strength compared with the contralateral side. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Prevalence of bowel symptoms in women with pelvic floor disorders.

INTRODUCTION AND HYPOTHESIS: To determine the prevalence of a variety of bowel symptoms in women with pelvic floor disorders METHODS: We reviewed charts of consecutive new patients presenting to our urogynecologic clinic between July 2006 and April 2008. Women completed two bowel symptom questionnaires: (1) a nonvalidated questionnaire inquiring about symptoms of fecal/flatal incontinence, painful bowel movements, difficulties in bowel movement, and the need for splinting and (2) the validated, Colorectal-Anal Distress Inventory (CRADI) subscale of the short form of the Pelvic Floor Distress Inventory. Demographic and clinical information were extracted from patients' charts. RESULTS: Four hundred sixty-three women were included. Only 3% of the women presented with defecatory dysfunction or fecal incontinence as their chief complaint. However, 83% answered affirmatively to the presence of at least one CRADI bowel symptom. The most common bowel symptom was incomplete emptying at the end of a bowel movement (56%), followed by straining to have a bowel movement (55%), and flatal incontinence (54%). CONCLUSIONS: Women rarely seek urogynecologic care primarily for bowel symptoms, although they have a high prevalence of bowel symptoms.