Sport injuries in adolescents.

In spite of the wide range of injuries in adolescents during sports activities, there are only a few studies investigating the type and frequency of sport injuries in puberty. However, this information may help to prevent, diagnose and treat sports injuries among teens. 4468 injuries in adolescent patients were treated over a ten year period of time: 66,97% were boys and 32.88% girls. The most frequent sports injuries were football (31.13%) followed by handball (8.89%) and sports during school (8.77%). The lower extremity was involved in 68.71% of the cases. Knee problems were seen in 29.79% of the patients; 2.57% spine and 1.99% head injuries. Injuries consisted primarily of distortions (35.34%) and ligament tears (18.76%); 9,00% of all injuries were fractures. We found more skin wounds (6:1) and fractures (7:2) in male patients compared to females. The risk of ligament tears was highest during skiing. Three of four ski injuries led to knee problems. Spine injuries were observed most often during horse riding (1:6). Head injuries were seen in bicycle accidents (1:3). Head injuries were seen in male patients much more often then in female patients (21:1). Fractures were noted during football (1:9), skiing (1:9), inline (2:3), and during school sports (1:11). Many adolescents participate in various sports. Notwithstanding the methodological problems with epidemiological data, there is no doubt about the large number of athletes sustain musculoskeletal injuries, sometimes serious. In most instances, the accident does not happened during professional sports and training. Therefore, school teachers and low league trainer play an important role preventing further accidence based on knowledge of individual risk patterns of different sports.It is imperative to provide preventive medical check-ups, to monitor the sport-specific needs for each individual sports, to observe the training skills as well as physical fitness needed and to evaluation coaches education.

Secondary nocturnal enuresis caused by central sleep apnea from Chiari malformation type 1.

OBJECTIVE: To report a novel cause of nocturnal enuresis (NE) and highlight the literature giving insight into this novel mechanism. PATIENT: A 12-year-old morbidly obese female with 2-year history of nightly secondary monosymptomatic NE. RESULTS: On evaluation, a history of severe sleep disturbed breathing was elicited. Anticipating obstructive sleep apnea (OSA), polysomnography was performed, detecting severe central sleep apnea (CSA) without OSA. Brain magnetic resonance imaging revealed severe Chiari malformation Type I (CM1) with abnormal cerebrospinal fluid dynamics. She had no other classic signs or symptoms of CM1. Neurosurgical decompression halted the NE and normalized nocturnal breathing and cerebrospinal fluid dynamics, confirming that the CSA was caused by the CM1 and resulted in the NE. A thorough literature review found no prior reports of CSA-induced NE. Since CSA and OSA differ by the absence of negative intrathoracic pressures in CSA, this case suggests that such pressures are not a key mechanistic component of SA-induced NE. CONCLUSION: This first report of secondary NE caused by CSA from CM1 emphasizes obtaining a sleep history in the enuretic child, introduces a new cause of NE, and challenges hypotheses underlying SA-induced NE.

Septic polyarthritis caused by Streptococcus pneumoniae: primary pneumococcal pneumonia as a risk factor in older patients? A case report.

Septic polyarthritis associated to Streptococcus pneumoniae pneumonia is rarely seen and deserves description. In the present report, the case of a 77-year-old man with a 3-day clinical history of arthritis lacking anamnesis of trauma is discussed. Physical examination showed inflammatory signs and elevated inflammatory parameters in blood samples. The patient experienced pneumonia with blood cultures positive for S pneumoniae simultaneously. Arthrotomy revealed putride arthritis with S pneumoniae in culture. Therapy was initiated with intravenous benzylpenicillin. Surgical drainage and frequent retesting managed the local infection. Antibiotics had to be changed according to the specific sensitivity to ceftriaxone. Antimicrobial therapy was given intravenously for a total of 6 weeks.On follow-up no inflammatory signs were observed after 4 and 9 months. A bistrategical approach with surgical drainage and frequent retesting and antimicrobial chemotherapy may lead to a good result in the treatment of pneumococcal septic arthritis.