Risk factors of multiple pulmonary emboli in an elite Ironman triathlete: a case report.

Objective: To present a unique case of pulmonary embolism (PE) in an elite-Ironman triathlete and review athlete-specific risk factors associated with venous thromboembolism (VTE). Case presentation: A 57-year-old male triathlete presented for chiropractic care of midback pain and dyspnea one day before competition. During competition, he was removed and unable to complete the event with dyspnea, chest, and midback pain. Vitals revealed prolonged elevated resting heart rate. He was triaged to the hospital with a high index of suspicion for PE. He was diagnosed with multiple PE in both lungs. Summary: VTE is not normally considered in athletes. A combination of athlete-specific risk factors may predispose athletes to a higher propensity of VTE. Due to life-threatening consequences, it is important to include a differential diagnosis of VTE in patients presenting with midback pain and dyspnea.

Objectif: Présenter un cas unique d'embolie pulmonaire (EP) chez un triathlète Ironman d'élite et passer en revue les facteurs de risque spécifiques aux athlètes associés à la thrombo-embolie veineuse. Présentation du cas: Un triathlète de 57 ans s'est présenté pour des soins chiropratiques en raison de douleurs au milieu du dos et de dyspnée un jour avant la compétition. Pendant la compétition, il a été évacué et incapable de terminer l'épreuve en raison d'une dyspnée, d'une douleur thoracique et d'une douleur lombaire. Les signes vitaux ont révélé une élévation prolongée de la fréquence cardiaque au repos. Il a été transféré à l'hôpital avec une forte suspicion d'EP. On lui a diagnostiqué une EP multiple dans les deux poumons. Synthèse: La thrombo-embolie veineuse n'est normalement pas envisagée chez les athlètes. Une combinaison de facteurs de risque spécifiques aux athlètes peut les prédisposer à une plus grande propension à la thrombo-embolie veineuse. En raison des conséquences potentiellement mortelles, il est important d'inclure un diagnostic différentiel de la thrombo-embolie veineuse chez les patients souffrant de douleurs lombaires et de dyspnée.

Cutaneous sensitivity in unilateral trans-tibial amputees.

AIM: To examine tactile sensitivity in the leg and foot sole of below-knee amputees (diabetic n = 3, traumatic n = 1), and healthy control subjects (n = 4), and examine the association between sensation and balance. METHOD: Vibration perception threshold (VPT; 3, 40, 250Hz) and monofilaments (MF) were used to examine vibration and light touch sensitivity on the intact limb, residual limb, and homologous locations on controls. A functional reach test was performed to assess functional balance. RESULTS: Tactile sensitivity was lower for diabetic amputee subjects compared to age matched controls for both VPT and MF; which was expected due to presence of diabetic peripheral neuropathy. In contrast, the traumatic amputee participant showed increased sensitivity for VPT at 40Hz and 250Hz vibration in both the intact and residual limbs compared to controls. Amputees with lower tactile sensitivity had shorter reach distances compared to those with higher sensitivity. CONCLUSION: Changes in tactile sensitivity in the residual limb of trans-tibial amputees may have implications for the interaction between the amputee and the prosthetic device. The decreased skin sensitivity observed in the residual limb of subjects with diabetes is of concern as changes in skin sensitivity may be important in 1) identification/prevention of excessive pressure and 2) for functional stability. Interestingly, we saw increased residual limb skin sensitivity in the individual with the traumatic amputation. Although not measured directly in the present study, this increase in tactile sensitivity may be related to cortical reorganisation, which is known to occur following amputation, and would support similar findings observed in upper limb amputees.

Preliminary observations on high energy phosphates and metabolic pathway and transporter potentials in extensor carpi radialis brevis and trapezius muscles of women with work-related myalgia.

This study compared both the extensor carpi radialis brevis (ECRB) and the trapezius (TRAP) muscles of women with work-related myalgia (WRM) with healthy controls (CON) to determine whether abnormalities existed in cellular energy status and the potentials of the various metabolic pathways and segments involved in energy production and substrate transport. For both the ECRB (CON, n = 6-9; WRM, n = 13) and the TRAP (CON, n = 6-7; WRM, n = 10), no differences (P > 0.05) were found for the concentrations (in millimoles per kilogram of dry mass) of ATP, PCr, lactate, and glycogen. Similarly, with one exception, the maximal activities (in moles per milligram of protein per hour) of mitochondrial enzymes representative of the citric acid cycle (CAC), the electron transport chain (ETC), and ß-oxidation, as well as the cytosolic enzymes involved in high energy phosphate transfer, glycogenolysis, glycolysis, lactate oxidation, and glucose phosphorylation were not different (P > 0.05). The glucose transporters GLUT1 and GLUT4, and the monocarboxylate transporters MCT1 and MCT4, were also normal in WRM. It is concluded that, in general, abnormalities in the resting energy and substrate state, the potential of the different metabolic pathways and segments, as well as the glucose and monocarboxylate transporters do not appear to be involved in the cellular pathophysiology of WRM.

Excitation-contraction coupling properties in women with work-related myalgia: a preliminary study.

We investigated the potential role of selected excitation-contraction coupling processes in females with work-related myalgia (WRM) by comparing WRM with healthy controls (CON) using tissue from extensor carpi radialis brevis (ECRB) and trapezius (TRAP) muscles. For the ECRB, age (mean ± SE) was 29.6 ± 3.5 years for CON (n = 9) and 39.2 ± 2.8 years for WRM (n = 13), while for the TRAP, the values were 26.0 ± 2.1 years for CON (n = 7) and 44.6 ± 2.9 years for WRM (n = 11). For the sarcoplasmic reticulum (SR) of the ECRB, WRM displayed concentrations (nmol·(mg protein)(-1)·min(-1)) that were lower (P < 0.05) for Total (202 ± 4.4 vs 178 ± 7.1), Basal (34 ± 1.6 vs 30.1 ± 1.3), and maximal Ca(2+)-ATPase activity (Vmax, 168 ± 4.9 vs 149 ± 6.3), and Ca(2+)-uptake (5.06 ± 0.31 vs 4.13 ± 0.29), but not SERCA1a and SERCA2a isoforms, by comparison with CON. When age was incorporated as a co-variant, Total, Basal, and Ca(2+)-uptake remained different from CON (P < 0.05), but not Vmax (P = 0.13). For TRAP, none of the ATPase properties differed between groups (P > 0.05) either before or following adjustment for age. No differences (P > 0.05) were observed between the groups for Ca(2+)-release in the SR for either TRAP or ECRB. Similarly, no deficiencies, regardless of muscle, were noted for either the Na(+)-K(+)-ATPase content or the α and ß subunit isoform distribution in WRM. This preliminary study provides a basis for further research, with expanded numbers, investigating the hypothesis that abnormalities in SR Ca(2+)-regulation are involved in the cellular etiology of WRM.

A pilot study to determine whether differences exist in histochemical properties between the trapezius and extensor carpi radialis brevis muscles in women with work-related myalgia.

To investigate fibre-type abnormalities in women with work-related myalgia (WRM), tissue samples were extracted from their trapezius (TRAP) and the extensor carpi radialis brevis (ECRB) muscles and compared with healthy controls (CON). For the ECRB samples (CON, n = 6; WRM, n = 11), no differences (P > 0.05) were found between groups for any of the properties examined, namely fibre-type (I, IIA, IIX, IIAX) distribution, cross-sectional fibre area, capillary counts (CC), capillary to fibre area ratio, and succinic dehydrogenase activity. For the TRAP samples (CON, n = 6; WRM, n = 8), the only difference (P < 0.05) observed between groups was for CC (CON > WRM), which was not statistically significant (P > 0.05) when age was used a covariant. A comparison of the properties of these 2 muscles in the CON group indicated a higher (P < 0.05) and lower (P < 0.05) percentage of type I and type IIA fibres, respectively, in the TRAP as well as higher (P < 0.05) CC, which was not specific to fibre type. These preliminary results suggest that the properties employed to characterize fibre types do not differentiate CON from WRM for either the TRAP or ECRB. As a consequence, the role of inherent fibre-type differences between these muscles in the pathogenesis of WRM remains uncertain.

Are abnormalities in sarcoplasmic reticulum calcium cycling properties involved in trapezius myalgia?: case studies on three females.

OBJECTIVE: The aim of this study was to demonstrate the feasibility of using samples obtained through muscle biopsy to assess a wide range of cellular properties, some of which may be abnormal in myalgia. Given the recent emphasis on the role of excitation-contraction coupling in health and disease, special emphasis is given to the characterization of the properties involved in this process. DESIGN: Tissue samples were obtained from the upper portion of the descending trapezius muscle in three female patients (PAT) with clinically diagnosed myalgia and assessed for a spectrum of properties related to substrate use, energy production, and excitation-contraction coupling and were compared with samples from three healthy controls. RESULTS: At the level of organization of the metabolic pathways, all PAT generally displayed normal activities of enzymes representing the potential for oxidative phosphorylation, glucose phosphorylation, glycolysis, and lactate oxidation. In contrast, a reduced potential was observed in PAT for both fat oxidation (-20%) and high-energy phosphate transfer (-38%). For excitation-contraction coupling, PAT had a compromised sarcoplasmic reticulum maximal Ca-ATPase activity (-21%), Ca uptake (-44%), and sarcoplasmic endopleasmic reticulum (SERCA) expression for both SERCA1a (-16%) and SERCA2a (-17%), which were accompanied by a lower phase 2 Ca release (-45%). The Na-K-ATPase concentration, the enzyme-regulating membrane excitability via active Na and K seemed elevated (+25%) in PAT. CONCLUSIONS: These results demonstrate the feasibility of analyzing tissue samples for a wide range of properties and provide a rationale for studies examining the cellular basis of myalgia with particular emphasis on sarcoplasmic reticulum Ca cycling, given the latter's role in regulating a wide range of cellular functions.