Medicolegal approach to skin lesions in trafficking victims: A case report.

Trafficking in human beings is an ancient phenomenon. The fight against trafficking in human beings is conceived as a priority by the European Union. Trafficked victims experience many types of abuse and neglect. Indeed, all human beings hold the right to have an identity and an estimated age as an assertion of their existence in the society, as expressly stated in the U.N. Convention on the Rights of the Child. Italy has been the scene of this phenomenon for many years. Since identification represents a fundamental human right and a prerequisite for any other measure of assistance and protection, the Italian procedure provides the execution of an interview and a forensic examination. This process takes time and requires willingness to listen and to create a trusting doctor-patient relationship. Although skin lesions in trafficking victims may be due to torture or other forms of mistreatment or abuse, they may also be related to ethnic practices. Here we demonstrate the importance of conducting a structured interview along with an accurate forensic examination to correctly discriminate the origin of skin lesions in trafficking victims.

Assessment and evaluation of predisposing factors to anterior cruciate ligament injury.

OBJECTIVE: Injury to the knee, specifically the anterior cruciate ligament (ACL), constitutes one of the most serious disabling injuries in sports. Women are reportedly at an increased risk. Prevention depends on identifying possible risk factors that may contribute to an athlete's susceptibility to injury. The major objective of this article is to lay the groundwork for standardization of a screening protocol (1) by providing rationale for the use of selected variables that might be good predictors of noncontact ACL injury and (2) by describing appropriate measurement indices to further investigate their predictive power. Standardization of a screening protocol is the first step in developing both a reliable and valid assessment tool with predictive value for injury and outcome strategies to meet the special needs of patients. DATA SOURCES: MEDLINE was searched from 1980 to 1998 using the terms "anterior cruciate ligament injury," "knee joint stability," "postural malalignments" "structural abnormalities," "static structural measures," "musculoskeletal strength imbalances," "isokinetic testing," and "functional performance tests." DATA SYNTHESIS: Many different factors, both extrinsic and intrinsic, have been investigated in the search for predictors of noncontact ACL injuries. Based on a literature review, 3 factors in particular have garnered considerable attention from clinicians and researchers: static postural malalignments with special reference to excessive foot pronation, knee recurvatum, and external tibial torsion; lower extremity musculoskeletal strength; and neuromuscular control considerations. However, much of the information known about the predictive value of these variables is inconclusive and conflicting at best, prompting the need for additional investigation. CONCLUSIONS/RECOMMENDATIONS: Screening evaluations are routinely employed as part of clinical work-ups when athletes are healthy and in top form. The data collected have the potential to provide clinicians with important baseline information for maximizing structural and functional outcome strategies when deficiencies in test results are observed in subgroups of athletes matched for age, sex, and training or performance expectations.

Family size and age at menarche in athletes.

The association between family size and age at menarche was evaluated in 370 university athletes representing seven sports, 291 white and 79 black. Age at menarche, number of children in the family (family size), and birth order were collected retrospectively by questionnaire with a follow-up interview if necessary. The effect of family size on menarche was estimated with linear regression and multiple regression. For each additional sibling in the family-age at menarche was later by 0.17 yr in white athletes, 0.21 yr in black athletes, and 0.16 yr in the total sample (about 2.0-2.5 months). The slopes for white (beta = 0.167) and black (beta = 0.208) athletes did not differ significantly. Controlling for the effects of birth order significantly increased the family size effect in white athletes (beta = 0.221), but not in black athletes (beta = 0.203) or in the total sample (beta = 0.164). The slopes for white and black athletes, after controlling for birth order, also did not significantly differ. Thus, after controlling for birth order, menarche was later by 0.16-0.22 yr (about 2.0-2.6 months) for each additional sibling in the family, which was within the range of family size effects observed in samples of nonathletes and athletes. The family size effect also persists after controlling for maternal age at menarche in a subsample of 134 athletes, thus implying an independent effect of family size. Later ages at menarche observed in athletes may thus be due in part to larger family sizes.

Age at menarche in athletes and their mothers and sisters.

Retrospective ages at menarche were obtained from 109 university athletes and their mothers, and from 77 sisters of the athletes. The athletes were participants in seven sports. Mean age (+/- SD) at menarche of the 109 athletes was identical with that of the total sample of 338 athletes from which they were drawn, 13.8 +/- 1.5 years. Mean age at menarche in the mothers was 13.4 +/- 1.7 years. When mothers were grouped as having been athletes (n = 52) or non-athletes (n = 57), menarcheal ages were, respectively, 13.7 +/- 1.8 years and 13.2 +/- 1.5 years. The mother-daughter correlation for age at menarche was 0.25. Corresponding correlations between athletes and mothers who were athletes and between athletes and mothers who were not athletes were 0.24 and 0.22, respectively. Ages at menarche in athletes who had sisters (n = 62) and their sisters (n = 77) were 14.0 +/- 1.4 and 13.6 +/- 1.6 years, respectively. The intraclass sister-sister correlation was 0.44. Familial resemblance in age at menarche in athletes, their mothers and sisters, is identical with that in the general population, and suggests that later menarche commonly observed in athletes is to a large extent familial.

A modified Bristow-Helfet-May procedure for recurrent dislocation and subluxation of the shoulder. Report of two hundred and twelve cases.

A modified Bristow-Helfet-May procedure was performed for recurrent dislocation or subluxation of the glenohumeral joint in 207 patients (212 shoulders), whose average age at the time of surgery was 20.3 years (range, fourteen to forty-seven years). The procedure was modified by directing the coracoid segment and conjoined tendon over the superior border rather than through the substance of the subscapularis tendon and muscle. The indications were either documented recurrent anterior dislocation of the glenohumeral joint or subluxation with instability as demonstrated on examination with the patient under anesthesia. The procedure was evaluated on the basis of the rate of recurrence of dislocation and subluxation, postoperative complications, the patients' subjective evaluation, and the effect of the procedure on the motion of the glenohumeral joint and the strength of the muscles of the shoulder as related to overhead throwing. Eight (3.8 per cent) of the shoulders redislocated and ten (4.7 per cent) had one or more subjective episodes of subluxation after the procedure. Complications included postoperative infection in two patients and problems with the screw that required its removal in ten. One hundred and thirty-one (62 per cent) of the patients responded to a questionnaire regarding their subjective evaluation of the results of surgery. Eleven (8 per cent) were unable to perform daily activities that involved overhead work, and forty-five (34 per cent) stated that they still had some degree of discomfort or pain in the shoulder. One hundred and twenty-six patients (96.2 per cent) stated that they were happy with the results of the surgery and would have the procedure again. Thirty patients had Cybex testing of the muscles of the shoulder. Only three (16 per cent) of the nineteen athletes whose dominant arm had been operated on returned to their pre-injury level of throwing. Data obtained with regard to changes in the range of motion and strength of the glenohumeral joint indicate that this loss of throwing ability was not due solely to a loss of glenohumeral motion. It appeared to be also related to a concomitant loss of strength at the extreme of external rotation of the humerus and the initiation of internal rotation of the humerus.

A preliminary study on the measurement of static and dynamic motion at the glenohumeral joint.

Measurement of glenohumeral joint motion has, for the most part, been performed with the simple goniometer. The purpose of this paper is to describe a method for measuring and recording static and dynamic external rotation of the glenohumeral joint using the Cybex II Isokinetic Dynamometer and an MFE model 815 X-Y plotter. Static range of motion was assessed at 60 deg/sec using a slow arm action externally from a 90 degree abduction position. Dynamic motion was recorded at 300 deg/sec using a rapid rotational whipping action from a 90 degree abducted position. Measurements were recorded on three groups of athletes, and the influences of sex, hand dominance, overarm activity, and surgery were analyzed. The subjects in the first two groups were divided according to sex and their participation in overarm versus nonoverarm (control) activities. Static and dynamic motion in both groups was significantly influenced by sex and hand dominance (P less than 0.05). Although there was no overall difference in the motion measurements between the control and overarm groups, the interaction of this factor with sex and type of measurement was significant. Males who participated in overarm activities had, on the average, more static range of motion than males in the control group. A third group that had undergone a modified Bristow procedure for recurrent dislocation/subluxation of the shoulder demonstrated that static and dynamic range of motion were significantly reduced by the surgery (P less than 0.05). The average differences in static and dynamic motion between the surgical arm and its nonsurgical counterpart were 17.5 degrees and 21 degrees, respectively, resulting in an overall range of motion difference of 19 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)

Adhesive strapping techniques.

The thoroughness of the clinical evaluation will dictate the necessity of adhesive strappings and their effectiveness in providing external support to injured areas. It is essential that the mechanism of injury and underlying anatomy be identified. In individual cases, the extent and severity of tissue damage will differ. Therefore, the methods of taping that have been presented are not inflexible, since variations may be necessary to insure proper support, protection, and comfort.