The endoscopic Draf II frontal sinusotomy: non-navigated approach.

OBJECTIVE: Endoscopic endonasal Draf II frontal sinusotomy is indicated for a variety of pathologies such as mucocele and non-responsive chronic frontal sinusitis. However, this approach is challenged and controversial. The objectives were to evaluate the advantages, disadvantages, indications, and rate of complications of this approach, without the use of a navigation system. METHODS: The files and computed tomography (CT) scans of 25 patients who underwent endoscopic endonasal Draf II sinusotomy at Assaf Harofeh Medical Center between 1999 and 2002 were reviewed. RESULTS: Thirty-one frontal sinuses were operated on and follow-up was between 18 and 62 months (average 30.3). Twenty-two sinuses (71%) had previous surgery. The Draf II procedure was used in 3.7% of all cases during the survey period. The most frequent indication for surgery was inflammation (48%) followed by mucocele (28%). In all but 2 sinuses (93%), the frontal floor between the lamina papyracea and the middle concha was drilled out. Twenty-four patients (96%) were successfully ventilated. No major complications were noted. CONCLUSIONS: The Draf II approach can be used safely and successfully without a navigation system, including cases of revision endoscopic sinus surgery. Correct interpretation of the surgical field and a CT scan are crucial for success. Careful patient selection is essential for this procedure.

Patellofemoral pain caused by overactivity. A prospective study of risk factors in infantry recruits.

A prospective study of 390 infantry recruits revealed that the medial tibial intercondylar distance and that the isometric strength of the quadriceps, tested at 85 degrees of flexion of the knee, had a statistically significant correlation with the incidence of patellofemoral pain caused by overactivity. Increased medial tibial intercondylar distance and increased strength of the quadriceps were therefore deemed to be risk factors for this syndrome.

Youth is a risk factor for stress fracture. A study of 783 infantry recruits.

We report a prospective study of 783 male Israeli recruits aged from 17 to 26 years. The risk of stress fracture was inversely proportional to age on both univariate and multivariate analysis. Each year of increase of age above 17 years reduced the risk of stress fracture by 28%.

Vasomotor rhinitis following trauma to the nose.

Complaints of nasal obstruction following nasal trauma without any deformation have been noticed by rhinologists for many years. However, neither an epidemiologic nor a pathophysiologic connection has ever been established. The complaints and physical examination findings of these patients resemble those of vasomotor rhinitis. Only very few articles suggesting nasal trauma as a possible cause for vasomotor rhinitis have ever been published. We present a retrospective study that found 87 of 802 patients to suffer from vasomotor rhinitis following nasal trauma. No other factors known to cause vasomotor rhinitis were present in these patients. None had any previous nasal problems. We therefore suggest that nasal trauma was the causative factor in their vasomotor rhinitis.

Nasal obstruction in the adult: is CT scan of the sinuses necessary?

OBJECTIVE: To determine whether CT (computerized tomography) scan of the paranasal sinuses is essential in the diagnosis and medical/surgical management of nasal obstruction. DESIGN: One hundred thirteen adult patients with nasal obstruction but without signs of sinusitis who underwent CT examination prior to surgery, were included in the study. RESULTS: Fifty seven percent of the CT scans revealed a variety of abnormal findings. Of the patients with an abnormal CT scan, surgical planning had to be altered in 16 patients due to significant abnormalities found on the CT scans. CONCLUSIONS: We conclude that CT scan of the nose and paranasal sinuses is an effective presurgical planning tool in patients with nasal obstruction.

Thyroglossal duct cyst: is thyroid scanning necessary in the preoperative evaluation?

BACKGROUND: Evaluation of thyroglossal duct cysts before surgical excision traditionally includes hormonal evaluation, ultrasound of the neck, and thyroid scanning. OBJECTIVE: To evaluate the need for thyroid scanning in cases of thyroglossal duct cysts scheduled for operation. METHODS: A retrospective chart review of 100 cases of thyroglossal duct cyst between 1988 and 1995 was carried out. RESULTS: No cases of ectopic thyroid were detected. CONCLUSION: Our goal was to document the presence of normal thyroid tissue by non-invasive tools such as ultrasound, rather than to rule out the existence of ectopic thyroid tissue by radionuclide scanning. Radionuclide scanning is justified in cases of lingual thyroid and where a normally located thyroid gland cannot be detected.

A prospective study of the effect of the appropriateness of foot-shoe fit and training shoe type on the incidence of overuse injuries among infantry recruits.

In a prospective study of the effect of the appropriateness of foot-shoe fit and training shoe type on the incidence of overuse injuries among infantry recruits, it was found that three shoe widths for each shoe length size were necessary to adequately accommodate the recruit population's foot anatomy. Recruits compensated for the lack of available shoe widths by choosing larger shoe sizes. However, this compensation did not result in an increase in the incidence of overuse injuries. Recruits who trained in basketball shoes had a lower incidence of overuse injuries of the feet than recruits who trained in infantry boots (p = 0.0001), but the overall incidence of overuse injuries was the same in both groups.

Risk factors for stress fractures among Israeli infantry recruits.

In order to answer the question of why the stress fracture morbidity rates among Israeli infantry recruits are so high, we prospectively evaluated 392 infantry recruits for risk factors for stress fractures. Prior to training, each recruit underwent a detailed evaluation. Using multivariate analysis, five risk factors for tibial fractures were identified: shorter tibial length (p less than 0.0001); relatively greater valgus knee alignment (p less than 0.002); right leg dominance (p less than 0.02); external rotation of the hip greater than 65 degrees (p less than 0.02); and training in specific subunits (p less than 0.0002., 0.03). No risk factors for femoral stress fracture were found by multivariate analysis.

The clinical assessment of femoral stress fractures: a comparison of two methods.

In a prospective study among 667 recruits, the incidence of asymptomatic femoral stress fractures was compared using a new expanded stress fracture clinical examination (SFCA) versus an older stress fracture examination. There was a statistically significant difference (p = 0.0001) between the percentage of femoral stress fractures that were asymptomatic in the group evaluated by SFCA (26%) and those evaluated by the older stress fracture examination (80%). By using the SFCA, many of the femoral stress fractures previously classified as asymptomatic are in fact recognized as symptomatic.

Inner ear damage in children due to noise exposure from toy cap pistols and firecrackers: a retrospective review of 53 cases.

This retrospective study presents the findings of inner ear damage documented in 53 children exposed to impulsive sound emitted by toy weapons and firecrackers. There were 49 boys and four girls aged between four and fourteen years. Thirty-nine children were affected unilaterally while fourteen had bilateral hearing loss (total of 67 ears). Most of the hearing loss (>70%) was sensorineural high frequency hearing loss, while only nine out of the 67 injured ears had sensorineural mid frequency hearing loss. Seven children sustained a traumatic ear drum perforation. Dizziness or tinnitus was reported by twenty children, with pathological ENG findings in four of them. This paper re-emphasizes the possibility of inner ear damage in children from exposure to noisy toys.

Marcher's digitalgia paresthetica among recruits.

In a prospective study of 30 male Israeli military recruits a 47% incidence of digitalgia paresthetica was found. The mean time of onset of symptoms was in the fourth week of training. The numbness was bilateral in 11 of 14 of the cases and the mean number of toes involved was 4.5. The first toe was the most commonly involved (11 of 14 patients). No correlation between shoe type (either 3/4 running shoes or standard military boots) was found. At 9-month follow-up, 7 of 9 affected recruits reviewed were asymptomatic. This finding suggests that marcher's digitalgia paresthetica is a neuropraxia. In this study, it developed during the early phases of march training when recruits are adapting to marching with heavy pack and rifle.

Treatment of overuse patellofemoral pain. Prospective randomized controlled clinical trial in a military setting.

The efficacy of treatment of overuse patellofemoral pain with an elastic knee sleeve with a silicone patellar ring was compared with a simple elastic sleeve and with no treatment in a prospective study of 395 army recruits. During 14 weeks of basic training, 84 knees were diagnosed as having overuse patellofemoral pain. Recruits treated with a simple elastic knee sleeve had a statistically significant better comfort score and more had their pain resolved by the end of training than those treated with elastic knee sleeves with a silicone patellar ring. The mean pain score at the end of training decreased more among recruits who were treated with a simple elastic knee sleeve than among recruits who received no treatment, but this difference was not significant. Among the treatment options tried, the simple elastic knee sleeve was no more effective than no treatment at all, but it was more effective than the more elaborate patellar brace.

Prevention of overuse injuries of the foot by improved shoe shock attenuation. A randomized prospective study.

In a randomized prospective study among 390 recruits, the hypothesis that improved shoe shock attenuation could lessen the incidence of overuse injuries was tested. During the 14 weeks of training, 90% of the recruits sustained overuse injuries. Recruits training in a modified basketball shoe had a statistically significant lower incidence of metatarsal stress fractures and foot overuse injuries, compared with standard infantry boots, but their overall incidence of overuse injuries was not reduced. The effect of improved shoe shock attenuation was limited to those overuse injuries resulting from vertical impact loads.

Anterior knee pain caused by overactivity: a long term prospective followup.

In a prospective study to determine the natural history of anterior knee pain caused by overactivity, 60 (15%) of 390 elite Israeli infantry recruits were found to have anterior pain in 77 knees during 14 weeks of basic training. At 6 years' followup, 3 years after returning to civilian life, half of the knees originally with anterior knee pain were still symptomatic, but in only 8% of the originally symptomatic knees was the pain severe, hindering physical activity. The long term prognosis of anterior knee pain caused by overactivity is much better than that reported previously for anterior knee pain in adolescents, but in a small percentage of cases the pain persists at a level that may prevent participation in exertional activities.

Risk factors for lateral ankle sprain: a prospective study among military recruits.

In a prospective study of risk factors for lateral ankle sprain among 390 male Israeli infantry recruits, a 18% incidence of lateral ankle sprains was found in basic training. There was no statistically significant difference in the incidence of lateral ankle sprains between recruits who trained in modified basketball shoes or standard lightweight infantry boots. By multivariate stepwise logistic regression a statistically significant relationship was found between body weight x height (a magnitude which is proportional to the mass moment of inertia of the body around a horizontal axis through the ankle), a previous history of ankle sprain, and the incidence of lateral ankle sprains. Recruits who were taller and heavier and thus had larger mass moments of inertia (P = 0.004), and those with a prior history of ankle sprain (P = 0.01) had higher lateral ankle sprain morbidity in basic training.