ABSTRACT
Esophageal cancer is on the rise. The known precursor lesion is Barrett's esophagus (BE). Patients with dysplasia are at higher risk of developing esophageal cancer. Currently the gold standard for surveillance endoscopy involves taking targeted biopsies of abnormal areas as well as random biopsies every 1-2 cm of the length of the Barrett's. Unfortunately studies have shown that this surveillance can miss dysplasia and cancer. Advanced imaging technologies have been developed that may help detect dysplasia in BE. This opinion review discusses advanced imaging in BE surveillance endoscopy and its utility in clinical practice.
Subject(s)
Barrett Esophagus/diagnostic imaging , Early Detection of Cancer/methods , Esophageal Neoplasms/diagnosis , Esophagoscopy/methods , Watchful Waiting/methods , Barrett Esophagus/pathology , Biopsy , Cost-Benefit Analysis , Early Detection of Cancer/standards , Esophageal Neoplasms/pathology , Esophagoscopy/economics , Esophagoscopy/standards , Esophagus/diagnostic imaging , Esophagus/pathology , Gastroenterology/standards , Humans , Microscopy, Confocal/economics , Microscopy, Confocal/methods , Microscopy, Confocal/standards , Narrow Band Imaging/economics , Narrow Band Imaging/methods , Narrow Band Imaging/standards , Practice Guidelines as Topic , Time Factors , Watchful Waiting/standardsABSTRACT
BACKGROUND: Monitoring pitch count is standard practice in minor league baseball but not in softball because of the perception that fast-pitch softball pitching is a less stressful motion. PURPOSE: To examine muscle fatigue after fast-pitch softball performances to provide an assessment of performance demand. STUDY DESIGN: Descriptive laboratory study. METHODS: Bilateral strength measurements (handheld dynamometer) were made on 19 female softball pitchers (mean age [±SD], 15.2 ± 1.2 years) before and after pitching a game (mean number of pitches, 99 ± 21; mean innings pitched, 5 ± 1). A total of 20 tests were performed on the dominant and nondominant sides: forearm (grip, wrist flexion/extension, pronation/supination, elbow flexion/extension), shoulder (flexion, abduction/adduction, external/internal rotation, empty can test), scapula (middle/lower trapezius, rhomboid), and hip (hip flexion/extension, abduction/adduction). Fatigue (percentage strength loss) was categorized based on bilateral versus unilateral presentation using paired t tests: bilateral symmetric (significant on dominant and nondominant and not different between sides), bilateral asymmetric (significant on dominant and nondominant but significantly greater on dominant), unilateral asymmetric (significant on dominant only and significantly greater than nondominant), or unilateral equivocal (significant on dominant only but not different from nondominant). RESULTS: Bilateral symmetric fatigue was evident for all hip (dominant, 19.3%; nondominant, 15.2%) and scapular tests (dominant, 19.2%; nondominant, 19.3%). In general, shoulder tests exhibited bilateral asymmetric fatigue (dominant, 16.9%; nondominant, 11.6%). Forearm tests were more variable, with bilateral symmetric fatigue in the elbow flexors (dominant, 22.5%; nondominant, 19.2%), and wrist flexors (dominant, 21.6%; nondominant, 19.0%), bilateral asymmetric fatigue in the supinators (dominant, 21.8%; nondominant, 15.5%), unilateral asymmetric fatigue in the elbow extensors (dominant, 22.1%; nondominant, 11.3%), and unilateral equivocal fatigue in the pronators (dominant, 18.8%; nondominant, 15.2%) and grip (dominant, 11.4%; nondominant, 6.6%). The mean (±SD) pitch velocity was 49 ± 4 mph, with a small loss of velocity from the first to last inning pitched (3.4% ± 5.0%, P < .01). CONCLUSION: Fast-pitch softball pitching resulted in profound bilateral fatigue in the hip and scapular muscles, with more selective fatigue in the shoulder and arm muscles. CLINICAL RELEVANCE: These findings emphasize the importance of strength in the proximal musculature to provide a stable platform for the arm to propel the ball.
