Distal Abdominal Oblique Avulsion Injuries in Two Collegiate Hockey Players: A Case Report.

ABSTRACT: While injuries to the abdominal oblique muscles near their origin at the lower ribs are commonly seen in sports that require explosive trunk rotational movements such as baseball and tennis, there are few reports in the literature of avulsion injuries to these muscles from their distal attachments at the iliac crest. We present the case of two collegiate male hockey players who suffered such injuries as a result of a direct impact mechanism while rotated at the waist. These injuries should be suspected when patients have significant pain in the lower abdominal region worsened by flexion and rotation of the trunk and can be accurately characterized by musculoskeletal ultrasound or MRI. With a conservative rehabilitation program focused on core, hip adductor, and hip flexor strengthening, our athletes were able to return to game participation within 6 wk of the initial injury.

Is Doppler echocardiography useful for estimating left ventricular filling pressures in pediatric heart transplant recipients?

LV E/E' ratio obtained using Doppler echocardiography is considered a surrogate for LV filling pressure in adults but has performed poorly in children. We hypothesized that LV E/E' ratio Z-score, adjusted for age, will relate more strongly to LV filling pressures than LV E/E' ratio in pediatric HT recipients. We analyzed 751 echocardiograms performed within 24 hours of a heart catheterization in 122 pediatric HT recipients (median age at HT 13 years, median 6 studies per patient). The primary end-point was PCWP, assessed both as a continuous and a binary variable. Associations with LV E/E' ratios and z-scores were assessed using generalized estimating equations models. PCWP, LV E/E' ratios (using E' from LV free wall, septum, and their average), and LV E/E' ratio Z-scores, all declined over time after HT. LV E/E' ratios and their Z-scores were significantly associated with PCWP assessed as a continuous variable (P < 0.001 for all); however, the relationship was weak (R2 range, 0.083 to 0.121). LV E/E' ratios and their Z-scores were also significantly associated with PCWP as a binary variable (P < 0.001 for all) but with only modest ability to discriminate PCWP ≥15 mm Hg (c-statistic range, 0.660 to 0.695). The association between LV E/E' ratio and PCWP in pediatric HT recipients is modest. Using a LV E/E' ratio Z-score did not result in significantly improved association with PCWP. Current Doppler echocardiographic methods are unreliable for estimating LV filling pressures in pediatric HT recipients.