[ABOUT ZONDA, PENROSE, STENT AND HEBREW AS A BONDWOMAN: SHOULD WE SEASON OUR LANGUAGE OR RATHER IMMERSE INTO IT?]

INTRODUCTION: The Israeli everyday medical slang includes foreign names. Some of these terms had already been translated to Hebrew, but are rarely in use. Terms such as "staung, schpadel, penrose, pinzette, tourniquet, gauze pad, PEG or retractor" are most frequently in use in foreign languages, as well as nouns like pasteurization, mesmerizing (hypnotizing) which originated from their historical developer. The authors believe that we will also continue to use these original foreign terms and eponyms in the future.

[ON THE BED AND BESIDE IT].

INTRODUCTION: Hospital beds are essential equipment for any hospital and clinical work. Various types of beds are in regular use in different medical branches. We survey historical points regarding the development of different types of beds, and medical eponyms, which connected to hospital beds. We must pay attention to the complications of prolonged confinement to bed.

Comparison of the Functional Outcomes of Lower Limb Amputees with or without End-Stage Renal Disease.

BACKGROUND: The potential for full rehabilitation following amputation among end-stage renal disease patients is poor. OBJECTIVES: To evaluate the functional outcomes and survival among amputees treated with hemodialysis at the end of the rehabilitation procedure. METHODS: We recruited 46 patients after lower limb amputation. Of these individuals, 19 (41.3%) were treated with dialysis and 27 (58.7%) were non-dialysis-dependent patients (NDDP). Both groups were divided into three sub-groups according to their independence with regard to activities of daily living (ADL) and their ability to walk with prostheses. RESULTS: The survival of lower limb amputees treated with dialysis was shorter compared to NDDP. Survival after amputation among the NDDP who were fully or partially independent in ADL and with regard to mobility, was longer compared to the non-mobile amputees as with the patients treated with dialysis. CONCLUSIONS: Survival was significantly longer in lower limb amputees NDDP and shorter in patients who did not achieve a certain level of functioning.

[HAMSTRING STRAIN INJURIES IN SPORTSMEN].

INTRODUCTION: Acute hamstring strain injuries are common in sports that involve sprinting, kicking, jumping or high-speed skilled movements. Despite increased knowledge of hamstring muscle injuries, the incidence has not diminished. It is generally believed that they happen during the terminal swing phase of the gait cycle. Most hamstring injuries occur along the proximal musculo-tendon junction, where the muscle fibrils intersect with the tendon, but may occur anywhere between the origin and the insertion. A number of potential risk factors have been proposed for hamstring strain, among them fatigue, lack of flexibility, imbalance of muscular strength with a low hamstring to quadriceps ratio, and insufficient warm-up. Certain types of hamstring injuries are more likely to require prolonged rehabilitation and delayed return to play. An emphasis on neuro-muscular control and eccentric strengthening of the involved muscles is suggested for the successful return to sport after injury.

[EXTRINSIC AND INTRINSIC FACTORS FOR FALLS THAT CAUSED HIP FRACTURE].

INTRODUCTION: Among the reasons described as possibly causing falls in older and elderly people are extrinsic factors such as bumping into objects, slipping on a wet floor, etc., and intrinsic factors - those that occur suddenly without warning. OBJECTIVES: To investigate the connection between the reasons for falls, extrinsic or intrinsic and different medical and nonmedical factors. METHODS: The survey included 82 people, 53 women and 29 men, who fell and broke their hip, underwent surgery, and were treated at the Rehabilitation Department. Data showed that 39 people fell due to extrinsic factors and 43 due to intrinsic reasons. We examined the correlation with several factors, both medical and non-medical, that may have influenced the scenario of each group. RESULTS: Falls due to extrinsic reasons took place at all hours of the day and night, mainly in people who were alone and who wore shoes or sandals at the time of the fall and who either suffered from slight or no disturbances in attention and concentration. Falls due to intrinsic reasons occurred mainly during rest or sleep hours, in people who walked barefoot or with socks or slippers and who suffered moderate or severe disturbances in attention and concentration. CONCLUSIONS: Although the differences in the extrinsic vs. intrinsic reasons for falls that led to broken hips were fairly clear, it would be difficult to recommend new tools for prevention of this phenomenon. Trying to predict an infrequent future event such as a traumatic fall is inherently difficult.

[The importance and composition of pre-season examination in sportsmen].

Every competitive athlete in Israel is required by law to undergo a periodical pre-participation physical examination (PPE), before the competitive season. The PPE is intended to discover medical problems which might affect the health of the athletes, and rarely, may even pose a risk to their lives. It includes a sports-oriented medical questionnaire, a thorough physical examination, and a resting electrocardiogram (ECG). From a certain age onwards, it also includes a graded exercise test (GXT). Numerous studies and standpoints of several professional committees and sports medicine organizations in Europe have emphasized the importance of the first 3 parts of the PPE, namely the questionnaire, physical examination, and resting ECG. Currently, the role of the GXT in the PPE remains debatable. In this review, we will discuss the latest available scientific information in favor of including a resting ECG and, sometimes, a GXT in the PPE of competitive athletes, as mandated by the Israeli Sports Law.

[Injured players candidates for professional volleyball team: sign them up or not?].

Competitive volleyball teams master six basic skills: serve, pass, set, attack, block and dig. Each of these skills comprises a number of specific techniques, considered standard practice in high-level volleyball. Five professional volleyball players were candidates to join a first division team in Israel. Their medical dossier presented previous injuries that occurred during their sport's activity. Two of the players had a suprascapular nerve injury, one had a lesion in the hamstrings, another one had an operated ankle sprain and the fifth one had an operated anterior cruciate ligament (ACL) tear in both knees and a mallet fifth finger. The team physician had to make the decision as to whether they are able to continue playing volleyball at a high level, taking into consideration the different skills necessary in this sport. Players having suprascapular nerve injury might have difficulties to hit the serve, to hit and to block the ball. Those with unstable knee or ankle take a risk white landing. Lesions in the hamstrings cause local pain during jumping to attack or to block the ball and a mallet finger will disturb the player when attempting to set the ball, to handle it in attack or to block.

Falls in stroke patients: risk factors and risk management.

BACKGROUND: Falls are common events among hospital inpatients and constitute a major health problem in the rehabilitation setting. Many risk factors for falls have been identified for stroke patients, such as muscle weakness, medication side effects, hypoglycemia, hypotension, etc. OBJECTIVES: To assess the risk factors for falls among patients hospitalized for rehabilitation following acute stroke. METHODS: In a retrospective study of 56 falls over a period of 5 years in 41 stroke patients hospitalized for rehabilitation we surveyed the nurses' safety risk assessment of the fall. Thirty patients fell once, 9 patients twice and 2 patients four times. The data were obtained from the medical and nursing records. Safety precautions were taken by the nurses for the entire group of patients. RESULTS: Most of the falls occurred among male patients who had reduced muscular tone (70%), paralysis (54%) and/ or hypoesthesia in the involved side of the body. Patients who suffered from hemiplegia fell more often than those with hemiparesis (Wilcoxon rank sum test, P = 0.04, one-sided). Forty-eight percent of the falls occurred during the first month after the last stroke, 70% during the morning or the afternoon, and 62% occurred close to the patient's bed. In 89% of falls the patients used hypoglycemic, antihypertensive, tranquilizing or neuroleptic drugs. Communication disorders (29%), hemianopia or blindness (21%) and visuospatial agnosia (18%) were incremental risk factors for falls. Fifty percent of the falls were caused by either an intrinsic or extrinsic mechanism. CONCLUSIONS: These data suggest that the group of stroke patients at risk for falls in a rehabilitation department can be identified by a variety of impairment and functional assessments. The information may be potentially useful for designing interventions directed at reducing fall frequency among stroke survivors.

[Utilization of prosthesis in patients who underwent below-knee amputation].

BACKGROUND: Thirty-two patients, among them 25 men (78.1%) and 7 women (21.9%), underwent surgery for below-knee amputation at the Western Galilee hospital, Nahariya, received a prosthesis and began rehabilitation treatment at the same hospital. Of these, 27 patients--21 men (77.8%) and 6 women (22.8%) responded to the authors request to complete the questionnaire. Four of these underwent bilateral below-knee amputation. The authors had no previous information about routine use of prosthesis after the termination of the rehabilitation process. METHODS: All patients who underwent a below-knee amputation between the years 2000 and 2004 and received a prosthesis thereafter, were surveyed. Each one was asked to complete a detailed questionnaire. The patients were asked about the use of prosthesis during daily activities, their mobility inside and outside the home, the possibility of returning to work, the influence on their social activity, the various complications caused by the prosthesis, the use of a walking aid, their ability to drive a car or to use public transport, and their ability to accomplish some physical tasks. The questionnaire included information about the patient's age, sex, level of education, civil status and familial support, in order to evaluate their influence on the use of the prosthesis. RESULTS AND CONCLUSIONS: The statistically significant results were all dependent upon the amputee's age. With an increase in age, the patient wears the prosthesis fewer hours per day inside and outside the home, has difficulty in walking quickly, tires earlier while walking and has a reduced quality of life.

Easy Technique for Radiographic Evaluation of Stump-socket Fit in Below-knee Amputees.

BACKGROUND: The alignment of a prosthesis affects the way load is transferred to the stump through the socket; this is critically important for its comfort and function. The aim of the study was to assess the value of radiopaque materials in evaluation of stump-socket fit in people with below-knee amputation. MATERIAL AND METHODS: Thirty-two amputees (skin breakdown group) had cutaneous lesions in the stump, and another 26 amputees (control group) had no lesion in the stump after training with their prosthesis. Metallic markers were attached to weight-bearing points in the internal socket. X-rays were taken in the antero-posterior and lateral projections. RESULTS: In the antero-posterior view, the weight-bearing points of the stump did not correspond to the metallic markers placed over the patellar tendon and the tibial tuberosity points in the socket in 78.1% of the 32 amputees in the skin breakdown group. This malalignment was present in 42.3% of the 26 amputees in the control group (Pearson Chi-Square, p<0.007). In the lateral view, in 65.6% of the 32, the weight-bearing points of the stump did not correspond to the metallic markers placed over the patellar tendon and the tibial tuberosity points in the socket. This malalignment was noted in 23.1% of the 26 patients in the other group (Pearson Chi-Square, p<0.002). CONCLUSIONS: 1. The conflict between the prosthesis and residual limb is the cause of skin disruption at different sites of the stump and can be successfully treated by prosthetic socket modification. 2. Efforts should be made to systematically identify any discrepancies between the stump and the soc-ket. 3. Correct adaptation of the prosthesis to the weight-bearing points of the stump will offer clinicians the possibility of quantification and visualization of this interaction using simple radiographic techniques.

Paraparesis after Spinal Anesthesia During Delivery.

Traumatic injury to the spinal cord during spinal or epidural anesthesia is usually secondary to either direct needle penetration or intra-neural injection of local anesthetics. Two women were admitted to a rehabilitation department with paraparesis and hypoesthesia after delivery. One had undergone a lower segment cesarean section under spinal anesthesia and the other, a spontaneous delivery under epidural anesthesia. After discharge from the rehabilitation treatment, they both experienced some weakness in the lower limbs. The patho-physiological basis of this complication seems to be either direct damage to the spinal cord by intra-neural injection of local anesthetics, or local ischemia.

Common peroneal neuropathy in patients after first-time stroke.

BACKGROUND: Common peroneal neuropathies, usually located at the fibular head, are one of the causes of drop foot, a condition often evaluated in the electromyography laboratory. OBJECTIVES: To study the motor conduction properties of the common peroneal nerve and its branches of distribution in patients with paralyzed drop foot, several weeks after their first stroke, assuming that its inversion position can cause neuropathy around the fibular neck. METHODS: We performed peroneal nerve conduction study on 76 legs of 38 patients, 12-73 days after their first stroke. All the patients had flaccid drop foot on the involved side. The stimulating electrode was placed at the postero-lateral aspect of the fibular neck. Motor nerve conduction latency and compound muscle action potential amplitude were measured along the proximal part of the deep and the superficial peroneal nerve, comparing the paralyzed to the sound leg. Paired sample t-test and paired t-test were used to compare the nerve conduction properties between the sound and the paralytic leg. The linear liaison between the two legs was determined by Pearson coefficient and the test based on it. RESULTS: The differences between motor conduction latencies and between CMAP amplitudes, comparing the paralyzed to the sound side, recorded in both the deep peroneal nerve and the superficial peroneal nerve, were statistically significant (P< 0.05). CONCLUSIONS: It seems that the permanent equino-varus position of the paralyzed foot might affect common peroneal nerve conduction properties at the level of the fibular neck by demyelination, axonopathy, or both. Possible reasons for these pathological changes are nerve traction or nerve compression, but temperature changes in the paralytic leg should also be considered. Ankle-foot orthoses can be prescribed for prevention or correction of deformities of the foot and ankle and reduction of the weight-bearing forces.

[Cycling after operation for total hip or total knee replacement].

Relatively few elderly people used to practice intensive and competitive sports activities. Following operations on joints of the lower extremity, such as total hip or knee replacement, most patients decrease their physical activity. Sometimes they are even unable to walk without an assisting device. The activation of the hip joint articulation among cyclists is very restricted, since the pelvis does not have practically any mobility. Lowering of the pedal, which requires the more important effort, is carried out by the extensors of the hip, but especially by those of the knee as well as the foot flexors. In cycling, the load on the articulations of the hips is practically reduced, in spite of the great effort. The load placed by the body weight on the hip joint, even in ascents, is reduced during this exercise, though the risk of prosthesis loosening is apparently very small. Knee joints are much more engaged during biking, but it is still considered as low-impact sport, compared to weight-bearing activities such as jogging and even walking.

[Morel-Lavallee syndrome after crush injury].

Closed internal degloving is a significant soft tissue injury associated with pelvic trauma in which the subcutaneous tissue is torn away from the underlying fascia, creating a cavity filled with hematoma and liquefied fat. It commonly occurs over the greater trochanter, but may also occur in the flank, buttock and lumbodorsal region, and it is known as a Morel-Lavallee lesion. The diagnosis of closed degloving injuries is based on physical and ultrasonographic examinations. The presence of a soft fluctuant area is the hallmark physical finding. Decreased cutaneous sensation is often associated with the skin over the area of degloving. Local contusion or other signs of injuries such as tire marks may also be present. In two separate cases, a 26-year-old woman and a 67-year-old man were injured in low velocity automobile accidents. During hospitalization, subcutaneous swellings were diagnosed as internal degloving injuries, and were drained several times by a plastic surgeon. A follow-up one year later revealed that the woman still suffered from swelling in the buttocks and thigh, though liposuction was successfully conducted; the man recovered completely from his injury after the conservative treatment. In most cases of degloving injuries, there is bruising of the skin or superficial hematoma, which resorbs spontaneously. However, in some cases, injury to the subcutaneous fatty tissue can result in the formation of a pseudocyst due to lymphatic extravasation. When hematoma or fluid collection does occur, puncture drainage and pressure therapy is usually considered to be sufficient treatment. Otherwise, surgical intervention must be proposed.

[Epidemiology of falls among stroke patients hospitalized in a rehabilitation unit: a three year survey].

BACKGROUND: Falls are major complications in inpatient stroke rehabilitation. The early identification of those at risk is an important issue in preventive strategies. AIMS: The study aimed to assess the risk factors for falls for patients hospitalized in a rehabilitation unit as a result of an acute stroke. METHODS: We studied a cohort of 36 falls in 25 patients during the years 2000-2002. The questionnaire on each patient included general and medical information and the description of the event. RESULTS: Eighteen patients fell once, five patients fell twice and two patients fell four times. In 89% of the falls, the patients were treated by tranquilizers, hypoglycemic, hypotensive or neuroleptic drugs. Most of the falls occurred in patients who suffered from hypotonus (72%), paralysis (58%) and hypoesthesia (52%) in the involved lower limb. A total of 67% of the falls occurred in males, 53% in patients over 65 years old, 47% during the first month after stroke and 36% in the second month. It was found that 78% of the falls happened during daytime and 64% took place in the patient's room. Communication disorders (28%), visuospatial agnosia (25%) and hemianopia (24%) were incremental risk factors for falls. CONCLUSION: Stroke is associated with a risk of falling during the rehabilitation period. The identification of patients at risk may be a first step toward the implementation of fall-prevention measures for these patients.

[Reasons for failure in gait rehabilitation after stroke, hip fracture and lower limb amputation].

During a period of 12 months, 136 patients were discharged from the rehabilitation unit into the community. This article retrospectively reviewed the discharge letter in the medical dossiers for these cases. The patient group included: seventy-one patients recovering after a first stroke and 25 after a recurrent stroke, 13 cases were operated after traumatic hip fracture, 15 were after below-knee amputation and one, after above-knee amputation. Eleven patients had other diseases or injuries. Patients were considered ambulators if they were able to walk independently, with or without assisting device, inside the department for a distance of at least 5 meters. Nonambulating patients could not walk or could walk only a few steps with full assistance, for a distance of less than 5 meters. Only 9 patients remained wheelchair dependents at the end of the rehabilitation period (6 after stroke, one after hip fracture and 2 amputees). The 6 stroke patients were all unable to support their body weight over the hypotonic paralyzed leg or to balance between the leg and the walking device. The only patient in this subgroup after hip fracture suffered from hemiplegia, contralateral previously operated hip fracture and Parkinson disease. Among the two amputees, one refused to continue the rehabilitation program and the other, suffered from motor and cognitive disorders following three episodes of stroke.