Safety of dry needling to the upper lumbar spine: a pilot cadaver study.

Objective: When inserting a dry needle laterally into the upper lumbar spine (L1-L3) there is an increased risk of piercing the kidney; therefore, the objective of this study was to determine a zone of safety for practitioners to needle in the upper lumbar spine.Methods: Ten cadavers were screened for inclusion. L1 spinous process was identified and confirmed with ultrasound imaging. A digital caliper was used to measure laterally at 1.5 cm, 2.0 cm, and 2.5 cm. Dry needles were inserted maximally at each point and a binary decision, yes or no, was made to determine if bony contact was made. Needle depth and abdominal width measurements were also recorded. Safety of the dry needling procedure was interpreted as such if bony contact was made by the needle. If bony contact was made, then it was assumed that the needle cannot advance further into pleura or kidney.Results: Forty-four percent of needles did not make bony contact at 2.5 cm lateral of the L1 spinous process, whereas 22% did not make bony contact at 1.5 cm and 2.0 cm. There was a weak to moderate negative correlation between abdominal width measurements and needle depth at 1.5 cm (-0.48) and 2.0 cm (-0.45), and at 2.5 cm (-0.39).Conclusion: A safety zone of needling less than 2.5 cm is likely safe, but needs to be confirmed with future study. Dry needling 2.5 cm lateral appears more risky due to the higher frequency of not contacting a bony backdrop.

Biomechanical differences related to leg dominance were not found during a cutting task.

Previous studies have shown conflicting information regarding leg dominance as an etiological factor for the risk of anterior cruciate ligament (ACL) injuries. It remains unclear if lower extremity neuromechanical limb asymmetries exist in experienced athletes. The purpose of this study was to evaluate lower extremity neuromechanical effects of leg dominance in female collegiate soccer athletes during an unanticipated side-step cutting task. Twenty female collegiate soccer players completed an unanticipated side-step cutting task, using their dominant and non-dominant legs. Kinematic and kinetic data were collected to quantify joint angles and forces, with wireless electromyography (EMG) quantifying muscle activity. MANOVA's were conducted to determine the effect of leg dominance on hip and knee mechanics at and between pre-contact, initial contact, peak knee adduction moment, and peak stance periods. Dependent variables consisted of peak time occurrences, hip and knee rotations and moments, ground reaction force, EMG amplitudes, stance time, and approach velocity. No significant differences were found for any variables at or between the periods of interest. Collegiate female soccer athletes exhibit similar movement patterns between dominant and non-dominant legs while performing a side-step cutting task, suggesting that leg dominance does not adversely influence known biomechanical non-contact ACL risk factors.

Differential effects of fatigue on movement variability.

When individuals perform purposeful actions to fatigue, there is typically a general decline in their movement performance. This study was designed to investigate the effects exercise-induced fatigue has on lower limb kinetics and kinematics during a side-step cutting task. In particular, it was of interest to determine what changes could be seen in mean amplitude and all metrics of signal variability with fatigue. The results of the study revealed that post-fatigue there was an overall decrease in absolute force production as reflected by a decline in mean amplitude and variability (SD) of the ground reaction forces (GRFV and GRFML). A decrease in mean and SD of the knee moments were also observed post-exercise. Interestingly, this trend was not mirrored by similar changes in time-dependent properties of these signals. Instead, there was an increase in the SampEn values (reflecting a more variable, irregular signal) for GRF force profiles, knee kinematics and moments following the exercise-induced fatigue. These results illustrate that fatigue can have differential effects on movement variability, resulting in a both an increase and decrease in movement variability, depending on the variable selected. Thus, the impact of fatigue is not simply restricted to a decline in force producing capacity of the system but more importantly it demonstrates that the ability of the person to perform a smooth and controlled action is limited due to fatigue.

Presencia del apéndice fibroso hepático: estudio de correlaciones bioantropológicas y su estructura

El apéndice fibroso hepático es una estructura anatómica del espacio subfrénico, poco descrita en la literatura universal y de importancia clínica. Se diseñó un protocolo para ser realizado en cadáveres donde se determina su presencia, características y correlación estadística con factores antropométricos. En 24 cadáveres se determina que el apéndice fibroso hepático siempre está presente, y que no existe correlación estadísticamente significativa, pero sí se observa variabilidad entre las dimensiones biométricas analizadas.

Arterias comunicantes del círculo arterial del cerebro: características biométricas y relación con el índice cefálico / Communicating arteries of the cerebral arterial circle: biometric features and their relation with the cephalic index

La clínica neuroquirúrgica tiene la necesidad de un acabado conocimiento anatómico de las arterias comunicantes como integrantes del círculo arterial del cerebro, por su variabilidad morfológica, su relación compleja con las estructuras adyacentes y por la alta frecuencia observada en la conformación de aneurismas. Debido a la importancia de estos vasos, efectuamos un estudio biométrico de los mismas, relacionando datos de calibre y longitud con índice cefálico. En el sexo masculino, el calibre promedio de la ACoP fue de 1,07 mm en el lado derecho y de 1,06 mm en el izquierdo; en el sexo femenino fue de 1,12 mm en el lado derecho y de 1,14 mm en el izquierdo. En el grupo de individuos con índice braquicéfalo, el calibre de la ACoP fue de 1,15 mm y en el grupo dolicomesocéfalo fue de 1,05 mm. Su longitud fue de 18,65 mm en los braquicéfalos y de 16,44 mm en los dolicomesocéfalos.El calibre de la ACoA fue de 1,53 mm en el sexo masculino y de 1,05 mm en el femenino, mientras que su longitud fue de 2,81 mm en el sexo masculino y de 2,33 mm en el femenino. La descripción biométrica y bioantropológica muestra parámetros importantes a considerar en la clínica quirúrgica.

The neurosurgical clinic needs extensive and thorough anatomical knowledge of the communicating arteries as part of the cerebral arterial circle for their morphological variability, their complex relation as adjacent structures, and for the frequency observed in the formation of aneurisms. Considering the importance of these vessels, we conducted a biometric study of these, relating caliber and longitude information to the cephalic index. In the male, the mean caliber of the PCoA < p was of 1.07 mm on the right side and 1.06 mm on the left; in the female it was of 1.12 mm on the right side and of 1.14 mm on the left. In the group of individuals with brachiocephalic index, the caliber of the ACoP was of 1.15 mm and in the dolichomesocephalic groups was 1.05 mm. Its longitude was 18.65 mm in the brachiocephalous and of 16.44 mm in the dolichomesochephalic. The caliber of the ACoA was of 1.53 mm in the male and 1.05 mm in the female, while its longitude was of 2.81 mm in the male and 2.33 mm in the female. The biometric and bioanthropologic description shows important parameters to be considered in clinical surgery.

[Ophthalmic presentation of two cases of esthesioneuroblastoma]. / Debut oftalmológico de dos casos de estesioneuroblastoma.

PURPOSE/METHOD: To report the ophthalmologic presentation of two cases of esthesioneuroblastoma (ENB). A comprehensive ophthalmic assessment was made, including magnetic resonance imaging. A paranasal sinus mass was biopsied in one case and a nasal mass biopsied in the other. CASES REPORT/DISCUSSION: Two women, aged 85 and 32 years respectively, presented to the emergency room with ophthalmic symptoms and signs. The first reported orbital pain and eyelid edema and the second, who was 22 weeks pregnant, reported a spontaneous lower eyelid haematoma, orbital pain and rhinorrhoea. ENB is a rare malignant tumour and its presentation with ophthalmologic symptoms and signs is very infrequent.

Debut oftalmológico de dos casos de estesioneuroblastoma / Ophthalmic presentation of two cases of esthesionneuroblastoma

Objetivo/Método: Presentar el debut de dos casos de estesioneuroblastoma (ENB) con manifestaciones oftalmológicas. Se realizó una exploración oftalmológica completa y estudios de imagen consistentes de Resonancia Magnética (RM). En un caso se realizó biopsia de una masa sinusal y en el otro de una masa nasal. Caso clínico/Discusión: Dos mujeres de 85 y 32 años, esta última embarazada de 21 semanas, acudieron de urgencia por síntomas y signos oculares. El primer caso refería dolor orbitario y edema de párpado y el segundo hematoma palpebral inferior espontáneo, dolor orbitario y rinorrea. El ENB es un tumor maligno poco frecuente que puede debutar con sintomatología oftalmológica

Purpose/Method: To report the ophthalmologic presentation of two cases of esthesioneuroblastoma (ENB). A comprehensive ophthalmic assessment was made, including magnetic resonance imaging. A paranasal sinus mass was biopsied in one case and a nasal mass biopsied in the other. Cases Report/Discussion: Two women, aged 85 and 32 years respectively, presented to the emergency room with ophthalmic symptoms and signs. The first reported orbital pain and eyelid edema and the second, who was 22 weeks pregnant, reported a spontaneous lower eyelid haematoma, orbital pain and rhinorrhoea. ENB is a rare malignant tumour and its presentation with ophthalmologic symptoms and signs is very infrequent (Arch Soc Esp Oftalmol 2008; 83: 317-320)

Aspectos Biométricos de las Arterias Cerebral Anterior en el Segmento Proximal (Al) y Carótida Interna / Biometrical Aspects of the Anterior Cerebral Artery in its Proximal Segment (Al) and Internal Carotid Artery

La conformación del círculo arterial cerebral tiene relevancia en la clínica neuroquirúrgica por la relación compleja que presentan las arterias que lo originan y su gran variabilidad Debido a a esto, hemos decidido efectuar un análisis biométrico de las arterias cerebral anterior (Al) y de la arteria carótida interna (ACI) por posible asociación o correlación en estas estructuras. El trabajo se realizó en 36 cerebros disponibles en los laboratorios y cuyos datos bioantropológicos estaban registrados. El segmento Al de la arteria cerebral anterior derecha tuvo una longitud y calibre promedio de 12,86+1.58mm y 2,37±0,68mm, respectivamente. En el lado izquierdo la longitud y el calibre promedio de esta arteria fue 12,62+1.96mm y de 2,42±0,75mm, respectivamente. El calibre del lado derecho de la ACI fue 3,84±0,68mm y del lado izquierdo fue 3,96±0,87mm. Se observó variabilidad anatómica de los componentes que constituyen el círculo arterial cerebral cuando se considera lado, sexo e índice cefálico.

The conformation of the arterial circle of the base of the brain has relevancy in the neurochirurgical clinic as the complex relation that there present the arteries that originate it and its great variability. Due to the high frequency the aneurysms observed in the anterior communicating arteries, besides too, in the precommunicating segment (Al) of the anterior cerebral artery, we have decided to carry out a biometrical analysis of these arteries and the ICA for research possible association or correlation in these arteries.The work was realized in 36 available brains in the anatomical laboratories. These specimens had bioanthropological data. The segment Al of the anterior cerebral artery observed a length of 12,86 ± 1.58 mm and presents a diameter of 2.37 ± 0.68 mm in the right side. In the left side the length of this one segment is 12. 62 ± 1.96 mm and presents a diameter of 2.42 ± 0.75 mm. The external diameter of the ACI in the right side was 3.84±0.68 mm and in left side was 3.96 ± 0.87 mm. It is observed variability of the components that constitute the arterial cerebral circle when it is considered to be the side, the sex and cephalic index.

[Painful ophthalmoplegia (pseudotumor of the orbit and Tolosa-Hunt syndrome)]. / Oftalmoplejía dolorosa (pseudotumor y síndrome de Tolosa-Hunt).

INTRODUCTION: The Tolosa-Hunt Syndrome (THS) and the Pseudotumor of the Orbit (PTO) each have three common clinical hallmarks: unilateral periorbital pain, cranial nerve palsies and a fast response to corticosteroid therapy. CASE REPORT: 48-year-old female with a right VI nerve paralysis, later develops a right III nerve paralysis. It is important to be able to differentiate between THS and PTO, and this is done on the basis of the complementary tests. DISCUSSION: Apart from neuroradiologic findings, the clinical presentation and histopathology of these two conditions are very similar, making it difficult to distinguish between them. Aspects common to both pathological processes are discussed.

Oftalmoplejía dolorosa (pseudotumor y síndrome de Tolosa-Hunt) / Painful ophthalmoplegia (pseudotumor of the orbit and Tolosa-Hunt syndrome)

Introducción: El Síndrome de Tolosa-Hunt (STH) y el Pseudotumor Inflamatorio Orbitario (PTO) presentan tres características clínicas comunes: dolor periorbitario unilateral, parálisis de pares craneales y rápida respuesta a corticoides. Caso clínico: Mujer de 48 años con paresia del VI par derecho, añadiéndose posteriormente paresia del III par derecho. Se plantea diagnóstico diferencial entre STH y PTO, resolviéndose en base a pruebas complementarias. Discusión: Aparte de las pruebas neuroradiológicas, la presentación clínica e histopatológica similar hace que sean dos enfermedades difíciles de diferenciar, discutiéndose los aspectos comunes de ambas enfermedades

Introduction: The Tolosa-Hunt Syndrome (THS) and the Pseudotumor of the Orbit (PTO) each have three common clinical hallmarks: unilateral periorbital pain, cranial nerve palsies and a fast response to corticosteroid therapy. Case Report: 48-year-old female with a right VI nerve paralysis, later develops a right III nerve paralysis. It is important to be able to differentiate between THS and PTO, and this is done on the basis of the complementary tests. Discussion: Apart from neuroradiologic findings, the clinical presentation and histopathology of these two conditions are very similar, making it difficult to distinguish between them. Aspects common to both pathological processes are discussed

Presencia del Apéndice Fibroso Hepático: Estudio de Correlaciones Bioantropológicas y su Estructura / Presence of Appendix Fibrosa Hepatitis: Study of Bioanthropological and Structure Correlation

El apéndice fibroso hepático es una estructura anatómica del espacio subfrénico, poco descrita en la literatura universal y de importancia clínica. Se diseñó un protocolo para ser realizado en cadáveres donde se determina su presencia, características y correlación estadística con factores antropométricos. En 24 cadáveres se determina que el apéndice fibroso hepático siempre está presente, y que no existe correlación estadísticamente significativa, pero sí se observa variabilidad entre las dimensiones biométricas analizadas.

The hepatic fibrous appendix is an anatomical structure of the subfrenic space scarcely described in the universal literature and of vital clinical importance. For their study a protocol was designed to be carried out in cadavers where its presence is determined, characteristic and statistical correlation with anthropometric factors. In 24 cadavers it is determined that the hepatic fibrous appendix is always present, and that correlation doesn't exist statistically significant among the analyzed anthropological factors, but it's possible to observe variability in it's dimensions.

Valvuloplastia aórtica durante la edad pediátrica: experiencia de 15 años / Aortic valvoloplasty in childhood: a fifteen year experience

Introducción: Previamente al inicio de la intervención quirúrgica, los pacientes con estenosis aórtica grave fallecían de manera precoz. En la década de los ochenta, se introduce el tratamiento no quirúrgico: la valvuloplastia percutánea. En general, la valvuloplastia aórtica con balón reduce el gradiente un 60 por ciento desde valores previos, sin incremento importante de la insuficiencia aórtica. Pocos estudios consiguen reunir en un mismo trabajo un número importante de casos y un seguimiento a largo plazo (15 años) para establecer variables pronósticas. Objetivos: Valorar los resultados inmediatos obtenidos mediante la valvuloplastia aórtica con balón en un grupo de edad pediátrica; la evolución ecocardiográfica a largo plazo, identificando variables pronósticas dela evolución; e identificar el grado de concordancia entre los estudios hemodinámicos y ecocardiográficos. Pacientes y métodos: Analizamos los resultados obtenidos en 75 procedimientos realizados en una población compuesta por 55 varones y 20: mujeres (2,75:1): con edades comprendidas entre 2,8 y 210 meses (90,93 ñ 64,25 meses). Se excluyó el grupo neonatal por tener una entidad propia diferencial. Se estudiaron e intervinieron todos ellos en el Servicio de Cardiología Pediátrica del Hospital "Ramón y Cajal" de Madrid, entre julio de 1986 y junio de 2001. El tiempo de seguimiento varió entre 0 y 180 meses (41,10 ñ 32,96 meses). Resultados: Los efectos inmediatos observados mediante estudio ecocardiográfico fueron un descenso significativo en el gradiente Doppler máximo (de 83,67 a 48,59 mmHg, p <0,0001) y en el gradiente Doppler medio (de 43,49 a 32,18 mmHg, p <0,0014), con incremento de la insuficiencia aórtica por encima de dos grados en sólo un 8 por ciento de los casos. Los estudios hemodinámicos, por su parte, reflejaron un descenso significativo de la presión sistólica del ventrículo izquierdo (de 153,89 a 123,90 mmHg, p <0,0001) y de la telediastólica (de 13,30 a 11,70 mmHg, p 4,039), con un aumento significativo también de las presiones aórticas sistólica, diastólica y media. El gradiente pico hemodinámico descendió de 71,93 a 30,37 mmHg, p <0,0001. La insuficiencia aórtica sólo se incrementó de manera significativa en un 5,3 por ciento. Durante el seguimiento ecocardiográfico, se demostró un aumento significativo del tamaño telediastólico del ventrículo izquierdo (VIDD), así como una reducción del gradiente Doppler máximo y medio. Las comparaciones entre los resultados ecocardiográficos y hemodinámicos fueron perfectamente equiparables en la valoración del tamaño del anillo aórtico y en la reducción del gradiente, pero no en el estudio del gradiente transvalvular. El análisis de supervivencia libre de intervención sobre la válvula fue del 90,88 por ciento a los 12 meses y del 78,65 por ciento a los 63 meses. El análisis de riesgos proporcionales mostró que el gradiente posvalvuloplastia resultante de la intervención se manifestaba como un factor pronóstico de posteriores intervenciones sobre la válvula. Conclusiones: La valvuloplastia aórtica con balón es un procedimiento efectivo tanto inmediatamente después de la intervención como a largo plazo, manteniéndose los resultados durante el tiempo de seguimiento. El porcentaje de éxito inicial se cifra en un 70 por ciento y, en la evolución, más del 90 por ciento de los niños queda libre de reintervención sobre la válvula a los 12 meses y casi un 80 por ciento a los 5 años. El gradiente posvalvuloplastia puede ser un buen factor pronóstico de futuras reintervenciones necesarias sobre la válvula. Las complicaciones obtenidas con este procedimiento han sido escasas, con tendencia a disminuir con la mayor experiencia técnica de los grupos y la mejor elección de los catéteres (AU)

Environmental effects of agri-environmental schemes in Western Europe.

Agri-environmental schemes (AES) have been introduced as part of European Union's (EU) Common Agricultural Policy and are now an important part of this. A methodological approach to analyse the policy effects of AES is outlined, in which we distinguish between performance effects (on agricultural practices) and outcome effects (environmental impact). The performance effects are further approached including measurement of improvement and protection effects based on 12 indicators on changes/maintenance of land use and agricultural management. Data from personal interviews of participating and non-participating farmers in AES measures in nine EU Member States and Switzerland were used to analyse policy effects, including single indicator effects on agricultural practices as well as combined effects at the agreement level. Significant effects were found for mineral N-fertiliser use, stocking density reduction, maintenance of a minimum livestock density and pesticides. For AES agreements regulating grassland management, fertiliser use and pesticides, clear indications of combined improvement and protection effects were found. In addition clear improvement effects of agreements regulating fertiliser and pesticides use on mainly arable lands were revealed. It is concluded that the approach presented including the 12 selected indicators has proven to be operational.

[Balloon valvoplasty for critical aortic valve stenosis in neonates]. / La valvuloplastia en la estenosis valvular aórtica crítica del neonato.

OBJECTIVES: To evaluate the immediate results obtained with balloon aortic valvuloplasty in neonates and long-term echocardiographic outcome as well as to identify variables predictive for outcome. To identify the degree of agreement between hemodynamic and echocardiographic study. PATIENTS AND METHODS: We analyzed the results obtained in 26 procedures performed in 18 boys and 8 girls (2.25:1), aged 2 to 49 days (16.1 12.9 days). All procedures were performed in the Pediatric Cardiology Unit of Ramón y Cajal Hospital in Madrid between June 1989 and June 2001. Follow-up was from 0 to 144 months (39.5 39.7 months). RESULTS: The immediate effects observed through echocardiographic study were a significant decrease in the maximum Doppler gradient (from 77.8 to 32.4 mm Hg; p < 0.0001) and in the medium Doppler gradient (from 41.7 to 18.5 mm Hg; p < 0.05). Hemodynamic studies showed a significant decrease in left ventricular systolic pressure (from 119.8 to 82.8 mm Hg; p < 0.0001) and an increase in aortic systolic pressure (from 56.8 to 66.6 mm Hg; p < 0.007). The hemodynamic peak gradient decreased from 63.1 to 17.7 mm Hg; p < 0.0001. In 23 % of the patients, aortic insufficiency significantly increased. Echocardiographic follow-up showed a significant increase in the telediastolic size of the left ventricle and a decrease in the maximum and medium Doppler gradient. The procedure showed initial success in 68.7 % and analysis of survival free of valvular surgery was 65.8 % at 45 months. Proportional risk analysis revealed that the post-valvuloplasty gradient was a predictive factor for future valvular surgery.

La valvuloplastia en la estenosis valvular aórtica crítica del neonato / Balloon valvoplasty for critical aortic valve stenosis in neonates

Objetivos: Evaluar los resultados inmediatos obtenidos mediante valvuloplastia aórtica con balón en el período neonatal, así como la evolución ecocardiográfica a largo plazo, identificando variables predictivas en relación a la evolución. Identificar el grado de concordancia entre los estudios hemodinámicos y ecocardiográficos. Pacientes y métodos: Se analizaron los resultados obtenidos en 26 procedimientos realizados en una población compuesta por 18 varones y 8 mujeres (2,25:1) cuyas edades fueron de 2 a 49 días (16,1 12,9 días). Todos fueron estudiados e intervenidos en el Servicio de Cardiología Pediátrica del Hospital Ramón y Cajal de Madrid, entre junio de 1989 y junio de 2001. El tiempo de seguimiento osciló entre 0 y 144 meses (39,5 39,7 meses). Resultados: Los efectos inmediatos observados mediante el estudio ecocardiográfico fueron un descenso significativo en el gradiente Doppler máximo (de 77,8 a 32,4 mmHg; p < 0,0001) y del gradiente Doppler medio (de 41,7 a 18,5 mmHg, p < 0,05). Los estudios hemodinámicos reflejaron un descenso significativo de la presión sistólica del ventrículo izquierdo (de 119,8 a 82,8 mmHg, p < 0,0001) y un aumento de la presión sistólica aórtica (de 56,8 a 66,6 mmHg, p < 0,007). El gradiente pico hemodinámico descendió de 63,1 a 17,7 mmHg, p < 0,0001). La insuficiencia aórtica se incrementó de manera significativa en el 23% de los casos. El seguimiento ecocardiográfico demostró un aumento significativo del tamaño telediastólico del ventrículo izquierdo (VIDD) y una reducción del gradiente Doppler máximo y medio. El porcentaje de éxito inicial fue del 68,7% y el análisis de supervivencia libre de intervención sobre la válvula se mostró del 65,8% a los 45 meses. El análisis de riesgos proporcionales demostró que el gradiente posvalvuloplastia resultante de la intervención era un factor predictivo de posteriores intervenciones sobre la válvula (AU)

Tribological study of lubricious DLC biocompatible coatings.

DLC (diamond-like carbon) coatings have remarkable tribological properties due mainly to their good frictional behavior. These coatings can be applied in many industrial and biomedical applications, where sliding can generate wear and frictional forces on the components, such as orthopaedic metal implants. This work reports on the development and tribological characterization of functionally gradient titanium alloyed DLC coatings. A PVD-magnetron sputtering technique has been used as the deposition method. The aim of this work was to study the tribological performance of the DLC coating when metal to metal contact (cobalt chromium or titanium alloys) takes place under dry and lubricated test conditions. Prior work by the authors demonstrates that the DLC coating reduced considerably the wear of the ultra-high-molecular-weight polyethylene (UHMWPE). The DLC coating during mechanical testing exhibited a high elastic recovery (65%) compared to the values obtained from Co-Cr-Mo (15%) and Ti-6Al-4V (23%). The coating exhibited an excellent tribo-performance against the Ti-6Al-4V and Co-Cr-Mo alloys, especially under dry conditions presenting a friction value of 0.12 and almost negligible wear. This coating has passed biocompatibility tests for implant devices on tissue/bone contact according to international standards (ISO 10993).

Augmented feedback reduces jump landing forces.

STUDY DESIGN: Randomized, experimental design using a 1-way ANCOVA to determine the influence of various forms of feedback on jump landing forces. OBJECTIVE: To investigate the effects of augmented feedback versus sensory feedback on the reduction of jump landing forces. BACKGROUND: Several investigators have reported an increased risk of lower extremity injury associated with landing from a jump. METHODS AND MEASURES: Nonimpaired college students (N=63) were randomly assigned to 1 of 4 feedback groups. Subjects were instructed to perform maximal vertical jumps onto a force plate for 3 testing sessions (baseline, 2-minute post-test, and 1-week post-test). Three feedback groups (augmented, sensory, and control I) were tested during all 3 testing sessions, while a fourth feedback group (control II) was evaluated at only 2 sessions (baseline and 1-week post-test). Subjects in the augmented feedback condition were provided information via video and verbal analysis of how to land softer. Subjects in the sensory feedback condition were asked to use the experience of their baseline jumps to document how they could land softer. Subjects in each of the control groups were not provided any extraneous feedback. Peak vertical ground reaction force data were collected for analysis. RESULTS: The subjects in the augmented feedback group significantly reduced their peak vertical ground reaction force in both post-test conditions (2-minute post-test reduction, 0.85+/-0.62; 1-week post-test reduction, 0.74+/-0.58) as compared to the sensory, control I, and control II feedback groups. CONCLUSIONS: High impact landing forces may be reduced by the implementation of augmented feedback information instructing individuals about how to land properly. The reduction of jump landing forces with the use of augmented feedback may prove beneficial in the creation of instructional landing programs.

[Addisonian crisis as first manifestation of adrenal gland insufficiency in patient diagnosed with lung cancer]. / Crisis addisoniana como primera manifestación de insuficiencia suprarrenal en paciente diagnosticado de cáncer de pulmón.

Adrenal insufficiency or Addison's disease is actually a rare illness associated with numerous pathologies. We describe the case of a fifty years old male with lung adenocarcinoma and metastasis in both adrenal glands, who was receiving chemotherapy with mytomicin, ifosfamide and cisplatin (MIC), and was diagnosed of adrenal insufficiency as a result of acute episode addisonian crisis. Many times, the clinic symptoms of adrenal insufficiency can go unnoticed due to its low specifity and to mixing up with other syndromes. Hypoadrenalism has been described in association with many tumours, specially with non-Hodgkin's lymphoma. It seems that there is a discordance between the number of patients with bilateral metastatic adrenal destruction and the documented cases of clinic insufficiency. Once the adrenal failure is suspected, the diagnosis and hormone replacement treatment are really easy. Addison's disease ethiologies are revised putting special emphasis on those related with cancer patients.

Crisis Addisoniana como primera manifestación de insuficiencia suprarrenal en paciente diagnosticado de cáncer de pulmón / Addisonian crisis as initial manifestation of adrenal insufficiency in a patient with lung cancer

La insuficiencia suprarrenal primaria o enfermedad de Addison es, actualmente, una patología infrecuente que se ha descrito asociada a múltiples causas.Presentamos el caso de un paciente de 50 años diagnosticado de adenocarcinoma de pulmón con metástasis suprarrenales bilaterales en tratamiento quimioterápico con mitomicina, ifosfamida y cisplatino (MIC), que se diagnostica de insuficiencia suprarrenal a raíz de cuadro clínico compatible con crisis addisoniana florida.Las manifestaciones clínicas de insuficiencia suprarrenal pueden pasar inadvertidas en muchas ocasiones, por ser inespecíficas y fácilmente enmascaradas por otras causas. Se ha descrito asociada a muy diversos tumores, sobre todo a linfomas no Hodgkin. Parece existir una discordancia entre el número de pacientes con destrucción metastásica adrenal bilateral y el número de casos de insuficiencia clínica descritos, lo que puede deberse a diversas causas. Una vez sospechada la confirmación diagnóstica y el tratamiento sustitutivo son relativamente sencillos. Se hace una revisión de las distintas etiologías de la enfermedad de Addison, haciendo especial hincapié en las relacionadas con enfermos neoplásicos. (AU)

A comparison of sideline versus clinical cognitive test performance in collegiate athletes.

OBJECTIVE: To test whether performance on 5 cognitive tests administered in a controlled clinical environment differed compared with administration in an uncontrolled sideline environment. Additionally, we investigated the effect of testing environment order on the learning effect for each cognitive test. DESIGN AND SETTING: Athletes were assessed on 2 test occasions (8 +/- 2 days apart), once in a sports medicine research laboratory and once on a lacrosse practice field site. SUBJECTS: A total of 59 Division I collegiate student-athletes participated in this study. MEASUREMENTS: Normative data were collected on 5 cognitive tests (Stroop Test, Trail-Making Test part A, Trail-Making Test part B, Wechsler Digit-Span Forward Test, and Digit-Span Backward Test). RESULTS: An independent-samples t test for environment difference on test day 1 revealed no significant differences between tests performed in the controlled environment and those performed in the uncontrolled environment. A repeated- measures analysis of variance test revealed a significant learning effect for all 5 tests, as subjects tended to improve approximately 11 points on the Stroop Test, 3 seconds on the Trail-Making A Test, 7 seconds on the Trail-Making B Test, and 1 point each on the Wechsler Digit Span Forward and Backward Tests. A paired-samples t test using delta scores (first test minus second test), sorted by order of testing environment, revealed a significant difference for the Stroop Test, but not for the remaining cognitive tests. CONCLUSIONS: There appears to be no difference in cognitive testing performance completed in a controlled clinical environment versus that performed in an uncontrolled sideline environment. This finding suggests that clinicians can administer cognitive tests to athletes with mild head injuries in uncontrolled sideline environments and expect valid results. Thus, clinicians can more thoroughly evaluate mildly head-injured athletes during the most crucial period after injury so that a safe return-to-play decision can be based on quantifiable, objective data.