Frequency of HLA-B27 subtypes in a Danish population and in Danish patients with ankylosing spondylitis.

Polymerase chain reaction in combination with sequence-specific oligonucleotide probes were used to analyze nine HLA-B27 subtypes among 51 healthy HLA-B27 positive Danish blood donors and 30 Danish HLA-B27 positive patients with ankylosing spondylitis (AS). In the group of healthy Danes we found two subtypes, B*2705 (90.2%) and B*2702 (9.8%), however, among the AS patients only the B*2705 subtype was detected. We did not find a significant evidence for associations between AS and a particular HLA-B27 subtype in a Danish population.

Short-term changes in the immune system of elite swimmers under competition conditions. Different immunomodulation induced by various types of sport.

This study was designed to investigate changes in the immune system of elite swimmers compared with well-conditioned age- and sex-matched controls in relation to a competition swim (field study). Furthermore, the aim was to reveal possible differences in immune system changes depending on the type of sport performed by comparing with an earlier study of similar design, from the same laboratory that tested elite runners in relation to a competition run. The swimmers were tested before, immediately after and 2 h and 24 h after a competition swim. Lymphocyte subsets (CD5, CD3, HLA-DR, CD4, CD8, CD19, CD3/CD16+56, CD57, CD18, CD16/CD122) all increased after the run, decreased to normal or subnormal levels after 2 h, and returned to normal after 24 h (absolute numbers). The findings were identical for the swimmers and the age- and sex-matched control group. No change in polymorphonuclear granulocyte migration was found. The lymphocyte proliferative responses decreased 2 h after the exercise. No changes were seen in plasma cytokine levels (interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-alpha) in relation to exercise, but significantly lower baseline values for IL-6 were observed in the swimmers. An increase in total natural killer cell activity immediately after exercise, followed after 2 h by a decrease, was seen in both swimmers and controls. Finally, no complement activation was detected. Compared with an earlier study of elite runners, differences were seen in granulocyte chemotactic response, TNF-alpha plasma activity and the lymphocyte proliferative response to mitogen. These differences might be explained by the degree of immune system activation following muscle damage during exercise, inducing an increase in cytokines, which are known to activate and modulate both lymphocytes and granulocyte function. Our findings demonstrate identical exercise-induced, immune system changes in elite swimmers and well conditioned controls, and furthermore, the findings suggest that different types of sport performed at maximum intensity induce different immune system changes.

Functional testing in lumbar nerve root compression syndromes. An evaluation in patients with normal neurological findings.

A functional test using downhill walking was evaluated in relation to the myelographical examination in 33 patients with a suspected lumbar nerve root compression syndrome despite normal neurological findings. Any changes of motor or reflex signs or of straight leg raising were accepted as test results. They were noted in a decision matrix and the positive and negative predictive value (PPV and NPV, respectively) calculated. The PPV of any deterioration of the neurological status resulting from the test as a sign of abnormal myelographical findings was calculated to be approximately 85 per cent, the corresponding NPVs being approximately 50 per cent. In its present form, this functional test is inadequate as a screening procedure in these patients.

Injuries among young soccer players.

We registered all new injuries among 496 male youth soccer players, aged 12 to 18 years, during the course of one year. The incidence of injury was 3.7 injuries per 1000 hours of soccer per player. The incidence increased with age, and at the higher ages within the youth players, approached the incidence rate of senior players (age greater than or equal to 18 years). Seventy percent of the injuries were located in the lower extremities, particularly the knee (26%) and ankle (23%). Back pain occurred in 14% of players. Fractures, which accounted for 4% of injuries, were most often in the upper extremities. We conclude that youth soccer is a relatively low-risk sport with an injury pattern that differs slightly from that of senior players.

Amateur boxing in Denmark. The effect of some preventive measures.

A survey of all amateur boxing matches in Denmark was made during a 3 year period. Data was gathered on means by which bouts were ended by the referee or attending physician, such as knock outs or blows to the head. A total of 5272 matches were fought: 3240 were senior matches (over age 19) and 2032 were junior matches (ages 17 to 19). Prophylactic intervention--unlimited length of hand bandage, voluntary use of boxing helmets, and heavier gloves for boxers greater than 149 pounds--did not affect the frequency of matches being stopped because of knock outs or blows to the head.

A new functional test in the diagnostic evaluation of neurogenic intermittent claudication.

A new functional test using downhill walking is described and evaluated in relation to the myelographical examination in 23 consecutive patients with neurogenic intermittent claudication. Discomfort and changes of the neurological status, emerging during the walk, were accepted as test results. They were noted in a decision matrix and the positive and the negative predictive values (PPV and NPV, respectively) calculated. The PPV of any symptom or any deterioration of the neurological status, resulting from this test as signs of a myelographical abnormality, was calculated to be 86 and 89 per cent, respectively, the corresponding NPV's being 50 and 40 per cent, respectively. The NPV of these parameters as signs of a myelographically verified lumbar spinal stenosis was calculated to be 100 per cent, the corresponding PPV's being 38 and 44 per cent, respectively. The development of "symptom-march" or of bilateral neurological signs during the walk was found to be of approximately the same diagnostical value. We conclude, that this function test may serve as a screening procedure in patients complaining of neurogenic intermittent claudication.

[Stretching in relation to sports and prevention of injuries]. / Straekøvelser (stretching) i relation til idraet og skadeforebyggelse.

Stretching is a regular item in training programmes and it is employed to increase flexibility, to prevent muscle tenderness, overuse injuries and strains. Stretching is carried out by stretching muscles and connective tissue to the extreme positions of joints. A review of stretching exercises based on the literature is presented in relation to prevention of injuries. The various techniques employed are reviewed.

The clinical significance of straight-leg raising (Lasègue's sign) in the diagnosis of prolapsed lumbar disc. Interobserver variation and correlation with surgical finding.

Limitation of straight-leg raising (SLR) (Lasègue's sign) is considered an important test in the diagnosis of herniated lumbar disc disease. In a prospective study of 55 patients suffering from unilateral sciatica this sign was evaluated. Two aspects were investigated: 1) the interobserver variation, and 2) the correlation between the result of the test and the surgical finding. There was considerable interobserver variation among three observers concerning the measured angle at which pain was elicited. However, in 2/3 to 3/4 of the cases the variation amounted to 10 degrees or less. There was also some discordance in the classification of the type of pain that was elicited. Fifty-two patients underwent surgery; 45 had a prolapsed disc. SLR was "positive" in 49 cases, 43 of whom harbored a prolapsed disc. Crossed SLR was noted in 20, 19 of whom had a prolapsed disc at surgery. Absence of SLR limitation does not preclude the presence of a herniated lumbar disc.

A man with nontraumatic symphysiolysis.

A case of nontraumatic symphysiolysis in a middle-aged man is described. In case of long-standing and unexplained discomfort in the lower abdomen in men, a radiographic examination with loading in order to evaluate the stability of the symphysis is recommended.

The epidemiology of ice hockey injuries.

As part of the injury profylaxes in Denmark a questionnaire investigation was undertaken in 14 randomly chosen ice hockey teams--out of 266 players, 210 answered (79%). The injury incidence per player per 1000 hours was 4.7, i.e. 1.5 in training and 38.0 in match. Half of the injuries were localised to the head (28%) and lower extremities (27%), 19% to the upper extremities and 7% to the back. Of these 48% were contusions. Knee and elbow injuries were of longest duration. The necessity for increased shock absorption in helmets and barriers as well as built-in rotational and collateral stabilizers in the existing knee protectors for injury prophylaxis is stressed.

Soccer injuries of youth.

During a soccer tournament with participation of 6,600 boys and girls (9-19 years) all injuries were evaluated, 5.2% of the players were injured; out of these 51% had "slight injuries", 42% "moderate injuries" and 7% "severe injuries". For the individual player the incidence of injury was 19.1/1,000 playing hours including all degrees of injuries; if "slight injuries" were excluded the incidence was 9.4/1,000 playing hours. The incidence rose with increasing age, girls were injured more often than boys. There were 81% of all injuries localised to the lower extremity, especially the ankle and foot. Contusion was the most frequent diagnosis, amounting to a third of all injuries. Blisters and exoriations amounted to nearly a fifth, 4% of the injuries were fractures, especially in the upper extremity; overuse injuries were seen only in 5.2% of the cases. Based on examination of the injury pattern in these children, injuries of youth seem to be relatively rare and mostly of a non-severe character.