Is active participation in specific sport activities linked with back pain?

A cross-sectional survey of 439 children/adolescents aged 12-13, living in Odense, Denmark, in the year 2001. To investigate (1) if there is any difference in back pain reporting among those practising specific sports as compared with non-performers and (2) if there is an association between specific kinds of sports and self-reported back problems. Back pain is a common complaint in young people and physical inactivity is generally thought to contribute to this. However, some specific sport activities may be detrimental or beneficial to the spine. Information was collected through a semi-structured interview, a physical examination, and a questionnaire. Associations for back pain, low back pain, mid back pain and neck pain in the preceding month were investigated in relation to specific sports. Associations were controlled for body mass index, puberty stage and sex. There was no association between back problems and the practising of sports in general. However, some sports were either positively or negatively associated with back pain. Taking into account the relatively small subgroups and multiple testing, some sports seem to be potentially harmful or beneficial. These sports should be investigated in proper longitudinal study designs, in relation to their effects on back problems in the young.

Detection rate of periintestinal lymph nodes.

AIM: Compared to standard two-dimensional (2D) endosonography, three-dimensional (3D) endosonography has been presented as a possible improvement regarding imaging of the gastrointestinal (G-I) tract and detection of metastatic lymph nodes. The aim of this study was to evaluate the efficacy of detecting periintestinal lymph nodes in surgical specimens using 3D endosonography. PATIENTS AND METHODS: Surgical specimens from 31 patients with malignant G-I tumours were investigated by 3-D endosonography and histology with focus on the presence of periintestinal lymph nodes and presence of metastasis. The specimens were scanned submerged into water. Position and size of the lymph nodes were mapped on a photo of the specimen both by the pathologist and the examiners. RESULTS: Three-dimensional endosonography detected 48 out of 60 malignant lymph nodes (80.0 %), and 110 out of 219 benign lymph nodes (50.2 %). The positive predictive value for an endosonographic finding interpreted as a lymph node was 0.97. CONCLUSION: The detection rates for periintestinal lymph nodes were relatively high and seemed superior to the one usually assigned to 2D endosonography. Although distinguishing between metastatic and non-metastatic lymph nodes remains a problem, all patients with histologically confirmed metastasis to lymph nodes were detected by 3D endosonography, and the technique thus seems suitable for grouping of patients prior to surgery.

Hyperplastic polyposis of the large bowel. Three cases and a review of the literature.

Small hyperplastic polyps of the large bowel constitute a frequent non-neoplastic lesion, whereas large or multiple hyperplastic polyps are rare. Here we report three cases of multiple small polyps together with some large hyperplastic ones. Two of the cases had a primary carcinoma in the bowel before onset of the polyps. The neoplastic potential of the hyperplastic polyp is discussed on the basis of the most recent investigations and the three presented cases. The hyperplastic polyp does not seem to be directly involved in the adenoma-carcinoma sequence, but dysplastic changes can be found in large hyperplastic polyps. In cases of multiple hyperplastic polyps a tendency towards a more uniform distribution of the polyps throughout the large bowel is observed. Hyperplastic colonic polyps may exist as a clinical entity, and a definition based on distribution, multiplicity, size, and symptoms is proposed. Patients with multiple or large hyperplastic polyps should have colonoscopy performed at short intervals, with removal of all lesions larger than 5 mm for histologic examination.

Atypical visual loss in giant cell arteritis.

Three patients with atypical ocular involvement due to histologically verified giant cell arteritis are reported. Prior to diagnosis, the first patient had periods of amaurosis fugax. He presented with normal vision. In spite of high-dose systemic corticosteroid therapy, he became blind in the terminal stage of his disease due to bilateral occipital cortex infarctions, verified by CT-scan. Autopsy revealed involvement of several intracranial arteries. In case No. 2 there was severe unilateral visual loss and cotton-wool exudates in both eyes. Central vision recovered after corticosteroid therapy; in our experience this is unusual. In case No. 3 irreversible unilateral visual loss was typical for GCA, but the association with polyneuropathy unique. Neurological remission coincided with systemic corticosteroid therapy.

Recurrent gastrointestinal bleeding due to leiomyosarcoma of the small intestine. Case report.

Three cases of small-intestinal leiomyosarcoma are presented. The neoplasms were located within 50 cm from the ligament of Treitz and the only symptoms was severe recurrent gastrointestinal bleeding. All the tumours were demonstrated at mesenteric angiography and were removed by simple resection of the tumour-bearing segment.

Multiple adenomas in terminal ileum 25 years after restorative proctocolectomy for familial adenomatous polyposis. Report of a case.

A patient with familial adenomatous polyposis was treated with colectomy, mucosal proctectomy, and a straight ileoanal anastomosis in 1962. Thirteen to 21 years later recurrent adenomas developed at the ileoanal anastomosis, and 25 years after the operation multiple adenomas were found in the terminal ileum up to 12 cm from the ileoanal anastomosis. It is concluded that colectomy and mucosal proctectomy, with or without an ileoanal reservoir, does not eliminate the future risk of adenoma formation. Thus, this method should be used only in selected polyposis patients.

The arterial blood supply of the parametrium.

The possible influence of tubal sterilization on the ovarian function is still debated. In this study, we have investigated the course of the main arteries in the parametrium. This study concludes that it is unlikely, from an anatomical point of view, that the ovarian function can be disturbed after tubal sterilization with bipolar cautery, silicone-rings or Filshieclips due to changes in the arterial blood supply.

PIP: 15 hysterectomy and bilateral salpingo-oophorectomy specimens were examined by dissection, after a sterilization procedure had been performed unilaterally, to follow the arterial supply to the adnexa. Because there have been reports of late sequelae of female sterilization, such as dysfunctional bleeding, dysmenorrhea, dyspareunia and pelvic pain, it has been postulated that sterilization may impair ovarian circulation. 15 women were subjected to preliminary unilateral sterilization by electrocoagulation, tubal rings, or Filshie clips before hysterectomy. The arterial system of the specimens were than perfused with methylene blue dye. Individual variability and within- individual variability in the course of tubal and ovarian circulation was the rule. Most specimens had an ovarian branch of the uterine artery that subdivided and travelled obliquely to the ovary and tube, but the route supplying the fallopian tube varied widely. A small artery lying beneath the tube would be affected by all types of sterilization. Possibly wider damage could occur from extensive electrocoagulation. The oblique branches of the uterine artery going to the tube and ovary would probably not be affected by sterilization. There is extensive collateral circulation, including a branch of the infundibulo-pelvic ligament that supplies ovarian circulation from the opposite direction. It was concluded that ovarian function is unlikely to be compromised by female sterilization.

Duodenal adenomas in familial adenomatous polyposis: their structure and cellular composition with particular reference to endocrine hyperplasia.

134 duodenal biopsies from 14 patients with familial adenomatous polyposis were evaluated by light microscopy for the presence of adenoma. Staining reactions for endocrine cells were applied. 90 biopsies contained adenoma, almost all of the tubular type (98%) with dysplasia, ranging from mild to moderate. Accompanying hyperplasia of argyrophil and argentaffin endocrine cells was found in 91% and 64% of the adenomas, respectively. Based on histological criteria it is concluded that the risk of carcinoma development in the duodenum could equal that in colon and rectum. The observation of endocrine hyperplasia is new, and further investigations are needed before the significance of this finding can be evaluated.

Electron microscopic studies of endocrine hyperplasia in duodenal adenomas in familial adenomatous polyposis.

Electron microscopical studies on endocrine cell hyperplasia of duodenal adenomas from five patients with familial adenomatous polyposis were performed. All the endocrine cell types normally found in the duodenal mucosa were identified. A constant feature was proliferation of duodenal-enterochromaffin cells but an increase in the number of all other endocrine cell types apart from pyloric-gastrin cells and somatostatin cells, was also observed. Certain types of intestinal endocrine cells (the intestinal enterochromaffin cell and the glicentin cell) are rare cells in the normal duodenal mucosa. The finding of these cells may indicate increased biological aggressivity.

Collagenous colitis.

Collagenous colitis is a very rarely recognized disease characterized clinically by watery diarrhoea and histologically by a broad, band-like deposition of collagen under the surface epithelium of the colon and rectum. Two cases of collagenous colitis are reported in this paper. After treatment of one of the patients with metronidazole, the symptoms cleared up and biopsy specimens from the colon showed regression of the pathological picture. The pathogenesis of the diarrhoea is discussed. The aetiological agent seems to be infectious, but is still unknown.