Pneumomediastinum in a female track and field athlete: a case report.

OBJECTIVE: To present the case of an elite female track and field athlete who suffered a pneumomediastinum resulting from a Valsalva maneuver performed while throwing the javelin. BACKGROUND: Episodes of chest pain and labored breathing in athletes may be alarming. Accurate, early diagnosis is enhanced by an awareness of those relatively rare conditions that may cause these symptoms. DIFFERENTIAL DIAGNOSIS: Bronchial injury/fracture, retropharyngeal abscess, acute pulmonary disease, pneumomediastinum, pneumothorax, cardiac disease, allergic reaction. TREATMENT: The athlete was given intravenous morphine for pain, prescribed oral pain medication, and restricted from strenuous activity for 6 weeks. Aerobic exercise was allowed after pain and air in the neck subsided, which was estimated at 1 week postinjury. UNIQUENESS: This is a rarely reported case of a pneumomediastinum in a female and a track and field athlete. CONCLUSIONS: Medical personnel must be aware of the possibility of pneumomediastinum in track and field athletes and in female athletes and must be knowledgeable in the followup care and the safe return of the athlete to activity.

Fatal childhood injury patterns in an urban setting.

STUDY OBJECTIVE: To describe fatal childhood injury patterns in an urban county and evaluate the use of the emergency medical services system. DESIGN: Retrospective chart review of medical examiner files, prehospital and hospital records, and police and fire personnel reports. SETTING: Milwaukee County, Wisconsin, an urban county with a population of approximately 1 million. PARTICIPANTS: All children 15 years old or younger who sustained a fatal injury in 1989 or 1990 (70). RESULTS: House fires were the leading cause of death by injury (34%), followed by firearms (19%), and drowning (11%). Motor vehicle occupant deaths occurred less frequently (7%). One-third of deaths were homicides (48% firearms and 30% assault). Twenty-four percent of deaths were pronounced at the scene, 12% were dead-on-arrival (no emergency department resuscitative efforts), and 37% were dead-on arrival ED resuscitations. Only 27% of victims survived to become inpatients (84% died within 72 hours). Mean scene time (16.1 +/- 7.9 minutes), transport time (9.5 +/- 5.1 minutes), and success rates for prehospital peripheral IV insertion (72%), endotracheal intubation (91%), and intraosseous line (86%) were not significantly different among those who were dead-on-arrival, dead-on-arrival failed resuscitations, or eventual inpatients. CONCLUSION: Fatal childhood injury patterns in this urban setting differed from reported national injury patterns. This study found a higher percentage of deaths from fire, gunshot wounds, and homicides but a lower percentage of motor vehicle-related deaths. Prevention strategies need to address the injury patterns of a particular community. Only a small percentage of victims survived to receive inpatient care following their injuries, suggesting that primary prevention of injury may be the most effective intervention.

Lemierre syndrome: the forgotten disease.

Lemierre syndrome is characterized by an acute oropharyngeal infection, suppurative thrombophlebitis of the internal jugular vein, anaerobic sepsis, and metastatic infections. Before the discovery of antibiotics, this disease usually was fatal. We report the case of a patient with all of these findings, indicating that Lemierre syndrome still is seen today. Prompt recognition, abscess drainage, and appropriate antibiotic coverage result in complete recovery in most patients.

A Comparison of Anterior and Posterior Cruciate Ligament Laxity Between Female and Male Basketball Players.

In brief: The incidence and severity of knee injuries is greater in female than male basketball players. To gain insight into this phenomenon, anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) laxity of 90 noninjured female and male high school basketball players were tested with an arthrometer and compared. With leg flexion of 25° ± 5° and 70° ± 5°, no statistically significant differences were found in ACL laxity, nor were significant right-left differences found. Differences in PCL laxity were not consistent. Thus, inadequate conditioning rather than laxity may be the major factor responsible for the higher incidence of knee injuries in female basketball players. If so, adequate preseason and inseason conditioning programs need to be implemented to correct this deficiency.