Prospective study of maturation and injury in elite handball academy. Could ‘maturational status’ be a risk factor for injury incidence in different handball team categories?

The objective of this study is to describe the relationship between injury incidence (IL) and maturity in male elite handball's player (HbP). Prospective study during two seasons, evaluating the sports injuries, maturity status and exposure time in hours in 133 young handball's players, under the UEFA methodology model for epidemiological studies. We discuss the maturity stage with different parameters, the Tanner's stage, puberty stages, peak high velocity, testicular volume, and the bone age. Finally, 190 injuries for a total of 34.222 h of exposure were registered. The average total Injury Incidence (IIn) by categories was 5,6 injury/1000 h of exposure. Injury Incidence during competition: 21,8 injuries/1000 hs and in training: 3,1 injuries/1000 hs without statistically significant between IIn, chronological age and different maturity stage by ANOVA. The multivariate statistical analysis registers tendency associations between IIn in competition for category (P = 0,07), and the IIn in training for Tanner stage (P = 0,091) and puberty (P = 0,021). In conclusion: there is not a significant difference in total IIn by ages categories in handball players but there is statistically significance tendency respect to some maturity parameters under a multivariate analysis. This last result must be considered when planning training seasons and strategies for injury prevention in the context of the formative handball. (AU)

Injury incidence and injury patterns by category, player position, and maturation in elite male handball elite players.

The aim of this cohort study is to estimate the influence of position, category, and maturity status on the incidence and pattern of injury in handball players, across two seasons. Injury registration from 164 players-season (12-27 years) was conducted, and players were categorized into youth (133) and adults (31), and per position: 27 goalkeepers, 67 backs, 70 wings and pivots. Maturity status in youth players was also measured by testicular volume on clinical examination (32 immature, 101 mature). 190 injuries occurred during 34 221 hours of exposure. Injury incidence in youth was 6.0 per 1000 total hours [CI 95%, 4.8-7.2] (14.9 match [9.7-20.1] and 3.7 training hours [2.7-4.6]; n= 142 injuries), and in adults 6.5 per 1000 total hours [4.4-8.6] (22.2 match [8.8-35.6] and 3.0 training hours [1.3-4.6]; n=48 injuries). There were significant differences in knee (P=0.01) and cartilage injury (P=0.05) according to playing position. There were significant differences according to age category in ankle (P=0.03), head (P=0.01), thigh (P=0.05) and muscular injury (P= 0.02), and apophysitis (P=0.04) for biological maturity state. Adult handball players had more ankle and muscle injuries than youths. Pivot and wings (2nd line) had more knee and cartilage problems. A higher incidence of apophysitis was found in immature youth players.

Cesárea en paciente con trombosis portal crónica y trombocitopenia: reporte de caso / Caesarean section in a patient with chronic portal vein thrombosis and thrombocytopenia: Case report

Abstract We report the case of a pregnant woman at term with primary anti-phospholipid syndrome, portal vein thrombosis, massive splenomegaly, oesophageal varices and thrombocytopenia. The patient underwent an elective caesarean section under general anaesthesia to minimise the risk of spleen and variceal rupture, with a favourable outcome for both the mother and the newborn. Chronic portal vein thrombosis is a rare condition, caused by various reasons, mainly thrombotic diathesis. It leads to increased portal pressure, with development of collateral circulation, splenomegaly and thrombocytopenia. Pregnancy in these conditions is considered high risk, but is not contraindicated if the underlying disorder is stabilised. The management of these patients should be multidisciplinary, under close monitoring; diagnosis and treatment of possible oesophageal varices is essential. The decision about mode of delivery and anaesthetic management must be individualised, depending on obstetric factors, the presence or absence of varices and thrombocytopenia, and associated comorbidities.

Resumen Presentamos el caso de una gestante a término con síndrome antifosfolípido primario, trombosis portal crónica, esplenomegalia masiva, varices esofágicas y trombocitopenia. La paciente fue intervenida mediante una cesárea electiva bajo anestesia general para minimizar el riesgo de rotura del bazo y de las varices, con un resultado favorable para la madre y el neonato. La trombosis portal crónica es una entidad poco frecuente, motivada por distintas causas, principalmente las diátesis trombóticas. Induce un aumento de la presión portal, con desarrollo de circulación colateral, esplenomegalia y trombocitopenia. La gestación en estas condiciones se considera de alto riesgo, pero no está contraindicada si la enfermedad está estabilizada. El manejo de estas pacientes debe ser multidisciplinar y su seguimiento, estrecho; el diagnóstico y tratamiento de las posibles varices esofágicas es esencial. La decisión sobre el modo de finalizar la gestación y el manejo anestésico deben individualizarse en cada caso, en función de factores obstétricos, de la presencia o no de varices y trombocitopenia, y de las comorbilidades asociadas.

Estudio prospectivo de maduración, desarrollo e incidencia lesional en balonmano formativo de élite. ¿Puede el estado madurativo ser un factor determinante de la incidencia lesional en balonmano? / Prospective study of maturity, development, and injury incidence in a professional Handball Academy. Could ‘maturational status’ be a risk factor for injury incidence in different handball team categories?

El objetivo de este estudio es describir la relación entre incidencia lesional (IL) y estado madurativo de jugadores varones de balonmano formativo (BmF) de alto nivel competicional. Se analizan durante 2 temporadas la incidencia de lesión deportiva de forma prospectiva en 133 jugadores, los criterios de maduración biológica y la carga física de exposición. Se siguieron los criterios para estudios de epidemiología lesional según el consenso UEFA. Las variables utilizadas para analizar el estado madurativo son los estadios de Tanner, la pubertad, el pico de velocidad de crecimiento, el volumen testicular y la edad ósea. Se registraron 190 lesiones para un total de 34.222 h de exposición. La IL total media de todas las categorías fue de 5,6 lesiones/1.000 h de exposición. En competición, el valor fue de 21,8 lesiones/1.000 h, y en entrenamiento, de 3,1 lesiones/1.000 h. No se encontraron diferencias estadísticamente significativas entre IL, la edad cronológica y los diferentes estados madurativos por ANOVA. El análisis estadístico multivariante registra cierta tendencia entre las asociaciones de IL en competición para categoría (p = 0,07), y en la IL en entrenamientos para Tanner (p = 0,091) y pubertad (p = 0,021). En conclusión, si bien no se detectaron diferencias significativas en la IL por edades en jugadores de BmF, sí se aprecia una tendencia real en determinados estadios madurativos mediante el análisis multivariante. Esto deberá tenerse en cuenta para planificación entrenamientos y estrategias de prevención de la lesión deportiva en el contexto del BmF

The objective of this study is to determine the relationship between injury incidence (IL) and maturity stage in male elite handball players. A prospective study was conducted during two seasons, evaluating the sports injuries, maturity status and exposure time in hours in 133 young handball players, using the UEFA methodology model for epidemiological studies. The maturity stage with different parameters is presented, as well as Tanner’s stage, puberty stages, peak high velocity, testicular volume, and the bone age. Finally, 190 injuries from a total of 34,222 hours of exposure were registered. The mean total Injury Incidence (IL) by categories was 5.6 injuries/1000 hours of exposure. Injury incidence during competition: 21.8 injuries/1000 hours and in training: 3.1 injuries/1000 h, with no statistically significant differences between IL, chronological age, and different maturity stages using ANOVA. The multivariate statistical analysis showed a tendency of associations between IL in competition category (P = .07), and the IL in training for Tanner (P = .091) and puberty (P = .021). In conclusion: There was a significant difference in total IL by age categories in handball players, and there was a statistically significance tendency as regards some maturity stages using multivariate analysis. This last result should be taken into account when planning training seasons and strategies for injury prevention in the context of the handball training

Epidemiología lesional del balonmano de elite: estudio retrospectivo en equipos profesional y formativo de un mismo club / Epidemiology of injuries in elite handball: Retrospective study in professional and academy handball team

Objetivo: Evaluar la incidencia y el patrón lesional en el balonmano de elite. Método: Estudio retrospectivo y transversal de 496 jugadores, de 29 equipos (divididos por categorías según edad y nivel), durante 5 temporadas (2007-2012), de un club del sur de Europa. El equipo médico evaluó las lesiones y el tiempo de exposición por equipos. Se siguieron los criterios epidemiológicos según consenso UEFA y codificación OSICS-10. Resultados: Se registraron 557 lesiones con 117.723 h de exposición totales. La incidencia lesional media de los equipos fue: 4,9 lesiones/1.000 h de exposición. Para el equipo Senior A (Profesional) fue de 4,3 (DE 1,8); Senior B, 3,4 (DE 1,6); Juvenil, 5,6 (DE 1,4); Cadete A, 5,5 (DE 2,5); Cadete B, 5,7 (DE 3,2), e Infantil, 4,9 (DE 1,9). No hubo diferencias estadísticamente significativas entre ellos, aunque los seniors tuvieron la mayor cantidad de horas de exposición (p < 0,001).Las localizaciones más frecuentes fueron tobillo (18,1%), rodilla (15,3%), muslo (12,9%) y región lumbar (10,6%). Las estructuras afectadas con más frecuencia fueron la lesión ligamentosa (27,3%) y la lesión «muscular por mecanismo indirecto» (20,5%). Esta última más en el Senior A, y la lesión ligamentosa en las categorías inferiores, aunque no se registraron diferencias significativas entre categorías. Conclusión: El patrón y la incidencia lesional en el balonmano de elite es uniforme entre los equipos de diferentes categorías, con pequeñas diferencias que deberán tenerse en cuenta para optimizar los programas de prevención en cada categoría del balonmano formativo de elite

Objective: To evaluate the injury incidence and pattern of injuries in elite handball by different ages. Method: A retrospective, cross sectional study, was conducted over 5 seasons (2007-2012), analyzing a total of 496 players, 29 teams (from different categories separated by age and performance level) of the same club in southern Europe. The same medical team has assessed the injuries and exposure time by teams. Epidemiological criteria according to UEFA and consensus OSICS-10 diagnostic coding were followed. Results: A total of 57 injuries were recorded during 117,723 hours of total exposure. There was a mean team injury incidence of 4.9 injuries/1000 hours of total exposure. For the Senior A (Professional Senior) it was was 4.3 (SD 1.8), Senior B (Amateur 18-28 years) 3.4 (SD 1.6), Youth (U-18 year) 5.6 (SD 1.4), Cadete A (U-16 year) 5.5 (SD 2.5), Cadete B (U-15 year) 5.7 (SD 3.2) and Infantil (U-14 year) 4.9 (SD 1.9). There were no statistically significant differences between categories, although seniors teams had more hours of exposure compared to other teams (P < 0.001). The most frequently affected sites were ankle (18.1%), knee (15.3%), thigh (12.9%) and lumbar region (10.6%). The most common type of injury to all teams was the sprain (27.3%) and non-traumatic muscle injury (20.5%). Muscle injuries were more common at Senior A (Professional) level, but in lower level teams it was the sprain, although there is no significant differences between them. Conclusion: The pattern and incidence of injury in elite handball is uniform between teams from different categories at the same club; with a few differences between each other that you should take this into account to optimize a preventions programs in each category of elite handball training

Intermittent ureterovesical junction obstruction in children.

While intermittent ureteropelvic junction obstruction is well recognized clinically, intermittent obstruction at the ureterovesical junction has not been previously described. We herein present a case report of intermittent ureterovesical junction obstruction, characterized by intermittent hydroureteronephrosis on ultrasonography and symptoms of flank/abdominal pain, nausea and vomiting.