Back injuries in the young athlete.

The diagnosis of back pain in the young athlete should be specific and not attributed to nonspecific, mechanical causes. Risk factor identification and intervention are required. Treatment is then initiated in a specific pattern, addressing flexibility and muscular imbalances. Bracing is often used to allow healing of growth tissue. The lumbosacral orthosis may be molded in a lordotic posture to unload the disc or antilordotic posture to relieve the posterior column; however, customizing the lordosis to the individual biomechanics may be required. Spinal stabilization is initiated with therapy for strengthening isolated weaknesses and progressing to coactivation and proprioceptive techniques, such as the balance ball. Returning to competition is preceded with sport-specific training.

The young dancer.

The injuries that are prevalent in and unique to dancers have their origins inextricably linked to faulty technique or poor biomechanics, combined with other risk factors. It is this combination of factors that must be addressed when considering diagnosis, treatment, and rehabilitation. For the dancer to return to full activity with minimal risk of recurrent injury, neuromuscular re-education is mandatory. This process best entails using a team approach, accessing the resources of healthcare professionals and those who train the dancer on a daily basis. In some cases, parents also may need to be involved. Communication, interaction, and mutual understanding among these groups will assist the dancer in regaining and maintaining health.

Idiopathic scoliosis and spondylolysis in the female athlete. Tips for treatment.

Idiopathic scoliosis and spondylolysis can be common back problems in female athletes. Diagnosis and treatment can be difficult. With the notable trend toward increasing participation of women and girls in organized sports, it is necessary to know which sports carry additional risks for participants to have these two conditions develop and to determine treatment modalities. In general, idiopathic scoliosis is more prevalent in females and even may be higher in the athletes. Treatment options may include observation, the use of a brace, and surgery. In determining treatment, the type of sport and caliber of athlete must be considered in conjunction with the severity of the curve. Spondylolysis or a stress fracture of the posterior vertebral elements can be a common cause of back pain in an athlete. In many sports that are dominated by females (gymnastics, dancing, figure skating), the athletes carry a high risk of having spondylolysis or a stress fracture. Knowing the risk factors permits precise diagnosis and appropriate treatment. Treatment options include the use of a brace and surgery. In the current study, an extensive review of the literature in conjunction with the extensive experience of a well-established sports medicine clinic at the authors' institution is presented.

Role remodeling and teamwork: priorities for managed care realignment.

The realignment of work and processes in MCOs is underway. Senior executives are now looking to senior health care managers for skills, behaviors, attitudes, thinking, and leadership that are very different from traditional expectations. To help define these revised expectations, a national survey was conducted of managed care executives who were asked to assess current versus future roles, values, and characteristics they see as essential to senior health care managers in managed care pharmacy.

Bucket-handle tear of the medial plica.

PURPOSE: The etiology of pathological media plica of the knee is unknown. We describe two cases of large, torn medial plicae. The cases help understand the etiology and avoid diagnostic pitfalls. CASE SUMMARY: Two patients with medial knee pain and pseudolocking were found to have "bucket-handle" tears of the large medial plicae. The pseudolocking phenomenon was observed arthroscopically in an effort to understand causation. DISCUSSION: Direct trauma and lateral traction are hypothesized to lead to thickened, pathologic medial plicae. A history of locking usually leads the examiner to look for torn menisci or loose bodies. These cases show that a medial plica with a longitudinal split can behave in a manner that can be mistaken for locking. The mechanism by which this occurs gives insight about the condition's etiology. RELEVANCE: Present treatment for painful medial plica is physical therapy, occasional corticosteroid injection, and arthroscopic excision when these efforts fail. Based on the evidence from these cases, a reasonable first step after diagnosing a traumatic, painful medial plica might be to selectively strengthen the vastus medialis obliquus.

Antiemetic therapy in managed care oncology: roundtable discussion.

Few diagnoses are feared more by patients than cancer. In addition to the life-threatening nature of many cancers, the spectre of very difficult the treatment provides patients with little or no level of comfort. However, recent advances in the treatment of the side effects of cancer chemotherapy are helping to change these attitudes. On April 4, 1996, a panel of experts was convened to discuss these issues and how they affect MCOs.

Public opinion and renal transplantation: results of a sample poll.

Organ transplantation is one of the most urgent and deeply felt problems in this day and age. It is a very delicate topic with its ethical, scientific, legal and political implications. Transplant surgery can be defined as a sure and irreplaceable opportunity capable of solving situations of life-threatening seriousness which could not otherwise be so effectively treated.

Back injuries in the young athlete.

Back pain in children and young athletes is very different from back pain in adults. Macrotrauma must be carefully evaluated and managed, even in the absence of definitive radiographic findings. Microtrauma must be suspected in at-risk athletes. These athletes require persistent diagnostic evaluation and may require SPECT bone scan to uncover a posterior element stress reaction. Atraumatic back pain requires the elimination of neoplastic, infectious, rheumatologic, or congenital causes.

[Public opinion and transplantation: results of a survey]. / Opinione pubblica e trapianti: i risultati di un'indagine.

General information on organ transplant is generally lacking and the issue very often arouses feelings of fear and suspicion. Aim of the survey was to assess the level of information of general population on legal, ethical aspects and other topics related to organ donation and transplant. A questionnaire was administered to a convenience sample of 700 inhabitants of Gallarate (MI). The open and closed questions explored areas such as the organ donation from a living person, xenotransplants, the role of media. 520 questionnaires (74.3%) were returned. There is a positive attitude toward organ donation but the specific knowledge of the large majority of people is very rough and superficial: for instance, only 36% of respondents knew the difference between organ donation from a living person and a corpse. The lack of correct information was considered the main reason (66%) for the insufficient number of organ donations.

Multisource drugs: implications and concerns in the geriatric population.

The demand for high-quality, cost-effective pharmaceuticals has increased. Much of this demand has evolved as a result of rising healthcare costs, state and federal entitlement programs, and third-party drug benefit restrictions. Patent expirations and changing patient demographics, as well as recent contributory forces, have fueled the need for multisource drugs and led to their greater availability. Legislative attention focused on the Food and Drug Administration and Abbreviated New Drug Application approval has had a positive effect on the multisource industry. The public is assured an era of vigilance, continual quality assessment, and greater integrity in the multisource drug approval process. The elderly are a rapidly growing population of prescription drug users who can benefit from cost-effective pharmaceuticals, such as those offered by multisource drugs. However, concerns and issues have arisen regarding the use of multisource drugs in the elderly. This article reviews these concerns and places into perspective the role of multisource pharmaceuticals in this population.

Complications experienced in the rehabilitation of zone I flexor tendon injuries with dynamic traction splinting.

A retrospective review of all flexor tendon repairs done between January 1985 to June 1987 determined the complication rate with our method of rehabilitation. One hundred sixty-three flexor tendon lacerations in 83 patients were reviewed. Follow-up ranged from 6 to 42 months. All patients participated in the same 12-week rehabilitation protocol. All patients had passive motion exercises of the interphalangeal joints in the first 2 weeks. We believe that passive stretching of zone I injuries during the first 2 weeks contributed to the zone I complication rate. Of the 20 patients with zone I tendon-to-tendon repairs, 7 patients had significant complications. The 35% complication rate found with zone I injuries has prompted us to modify our postoperative rehabilitation protocol in zone I injuries.

Further experience in rehabilitation of zone II flexor tendon repair with dynamic traction splinting.

A review of all flexor tendon repairs in the "no man's land" performed from January of 1985 to June of 1987 was done to evaluate the efficacy of our method of rehabilitation. There were 60 fingers (57 patients) with complete laceration of the flexor digitorum profundus and flexor digitorum superficialis tendons in zone II. Fingers with phalangeal fractures, joint injuries, or significant skin loss were excluded. Follow-up ranged from 12 to 48 months. Rehabilitation consisted of a 12-week protocol using the U.S. military combined regimen of controlled motion. Features from the technique of controlled active extension against rubber band passive flexion as well as those of controlled passive extension and passive flexion were incorporated. The palmar pulley modification of Kleinert's dynamic traction splint was utilized. Strickland's total active motion formula was employed to determine results. The results were classified into the four categories of excellent, good, fair, and poor. Fifty-two fingers (86 percent) were rated excellent, 4 fingers (7 percent) were rated good, 1 finger (2 percent) was rated fair, and 3 fingers (5 percent) were rated poor.

Neurovascular Complications Resulting From Corticosteroid Injections.

In brief Corticosteroid injections can be used effectively to treat shoulder problems, but they can be dangerous; direct injection into the nerve can result in a serious complication such as permanent axillary palsy.

Individualized assessment of the older patient.

The increase in the elderly population has influenced health care policy and economics to the point where even drug therapy for this group must be re-examined. Important drug use issues in the elderly include inadequately defined goals, multiple illnesses/multiple drugs, adverse reactions, pharmacokinetics/pharmacodynamics, compliance, and self-care. Specific strategies for dealing with each of these issues are acceptability/suitability of specific drugs, formalized compliance analysis, cooperative monitoring and profiling, effective patient communication, and patient education.

Patella alta and the adolescent growth spurt.

The presence of patella alta has been linked to recurrent dislocation of the patella and the patello-femoral stress syndrome. It is not known whether patella alta is an inherited or acquired trait. To investigate the relationship of patella during the adolescent growth spurt, serial orthoroentgenograms (growth study films) were retrospectively analyzed in 19 patients. Two were found in whom proximal patella migration could be correlated (r = 0.85) with femoral growth rate. This was significant at the p = 0.01 level. Girls had a higher correlation of patella height to growth rate than boys. In certain cases, patella alta is an acquired rather than inherited condition; this supports the theory that overgrowth during the growth spurt can lead to patella alta in some individuals.

Arthroscopic percutaneous lateral patellar retinacular release.

Thirty-four arthroscopic lateral patellar retinacular releases in 26 patients were evaluated retrospectively. Patients were carefully assessed for residual pain; they were also evaluated by various physical examination criteria. In addition, objective measurements of quadriceps and hamstring strength were obtained with the Cybex II Isokinetic Dynamometer. The surgical technique and postoperative management are presented. Overall, there were 9% excellent results, 53% good results, 26% fair results, and 12% poor results. A total of 64.7% of the knees were improved by the procedure.