Lacunar stroke in a hypertensive football player: implications in managing hypertension in athletes.

PURPOSE: A 28-year-old hypertensive professional football player suffered a lacunar stroke. Given the rarity of stroke at this young age, the contributory roles of hypertension and competitive athletics merit consideration. CASE SUMMARY: A 28-year-old defensive lineman, with long-standing, albeit recently well-controlled hypertension, experienced slurred speech and veering to his right after a game. Computerized tomography revealed a small internal capsule infarct. Diagnostic investigation, including coagulation profiling, sickle screen, antiphospholipid antibody, carotid imaging, and echocardiography did not reveal a cause. The patient recovered within days with no residual impairment. DISCUSSION: Despite the extreme blood pressure elevation associated with isometric straining in young athletes, stroke almost never occurs. Vascular changes resulting from chronic hypertension and/or marked volume depletion, and hemoconcentration resulting from restricted salt intake, diuretic use, and heavy sweating, offer the only explanations for this stroke. RELEVANCE: The case suggests physicians should exercise caution in using diuretics and salt-restricted diets to treat hypertensive athletes. Guidelines for treatment are discussed.

Symptomatic ossification of the tibiofibular syndesmosis in professional football players: a sequela of the syndesmotic ankle sprain.

Ankle syndesmosis sprains are common injuries in collegiate and professional football. Several reports have documented that patients with syndesmosis injuries require a longer time to return to full athletic participation than patients with lateral ankle sprains. Here we present the cases of two professional football players with ankle pain secondary to syndesmosis ossification following documented syndesmosis ankle sprains. Both patients eventually required resection of the heterotopic ossification to allow a pain-free return to football. We conclude that syndesmosis ossification may be symptomatic in some patients, and surgical excision of the ossification may be required to allow an asymptomatic return to sports.

Model for generating global images of emission from the thermosphere.

A general model is presented for the production of images of thermospheric dayglow emissions. Ultraviolet images are generated that are relevant to remote sensing of the principal constituents of the thermosphere (O and N(2)) and the ionosphere (O(+)). The emission features considered here are 1356-Å (O), Lyman-Birge-Hopfield bands of N(2) between 1650 and 1715 Å, and 834 Å (O(+)). The MSIS-86 and International Reference Ionosphere models were used as climatological representations of the distributions of neutrals and ions, respectively. We describe the generation of the images beginning with the production of volume-emission-rate profiles. A detailed description of the generalized image-generation technique is given. This technique permits us to change the observer's altitude and viewing geometry without incurring a large computational burden. The images produced by this technique demonstrate the potential of airglow imaging systems for remote sensing of global variability in thermospheric composition.

Influence of staging in superior sulcus (Pancoast) tumors of the lung.

Fifty-three patients with superior sulcus (Pancoast) tumors of the lung followed for up to 12 years by the Armed Forces Central Medical Registry were divided into three groups. In Group 1, preoperative stagin as determined by bone, brain, and liver scans or combinations thereof and the presence of local nodal extension as determined by mediastinoscopy or scalene fat pad biopsy were negative. These 16 patients received preoperative irradiation followed by en bloc resection of the lung and of the involved chest wall in most of them. Five-year survival as determined by the actuarial method was 49.7%. The 12 patients in Group 2 either had localized nodal involvement or were not diagnosed preoperatively. Survival in this group was 13.1%. Group 3 patients were considered inoperable and were given palliative irradiation. There were 25 patients in this group, and survival was 5.5% at 4 years. It would appear that preoperative irradiation and en bloc resection give improved survival in those patients judged free from metastatic disease preoperatively.

Childhood bronchial mucoepidermoid tumors: a case report and review of the literature.

A bronchial mucoepidermoid tumor in a 13-year-old female was studied by light and electron microscopy. This is the seventh reported case of this rare bronchial neoplasm in a person less than 16 years of age and the only case, in any age group, which has been studied ultrastructurally. All reported cases of bronchial mucoepidermoid tumors in childhood have been histologically of the low grade (well differentiated) variety with a benign clinical course. Although there are histological features which distinguish this lesion from the even rarer bronchial mucous gland adenoma, the clinical features and biological potential of the two lesions in this age group appear to be identical. The optimal surgical therapy for bronchial mucoepidermoid tumors and mucous gland adenomas, when occurring in children, is identical. There must be total removal of either lesion with the sacrifice of as little normal lung as possible. When technically possible, a sleeve resection of the involved bronchus is recommended; however, in most cases, the location of the lesion requires a lobectomy for complete removal.