Poor cervical proprioception as a risk factor for concussion in professional male rugby union players.

BACKGROUND: Concussion is one of the most common injuries in male professional Rugby Union ('rugby') and accounts for significant time loss from training and competition. Despite the most recent Concussion in Sport Group consensus statement recommending a focus on the identification of modifiable risk factors, limited evidence for their existence is available. OBJECTIVE: To investigate the association between cervical proprioception and concussion incidence in a group of professional male rugby players over the course of a full season. METHODS: 165 players were assessed at pre-, mid- and end of season time points using the Cervical Joint Position Error Test (CJPET). Associations with diagnosed concussion injuries are presented as incidence rate ratios with 95% confidence intervals. We present the Incidence Rate Ratios (IRR) for a 10% increase in each variable and compared results against concussion using match minutes to account for risk exposure. RESULTS: During the study period, 45 concussions were incurred by 44 players [or 19.7 concussions per 1000 player-match hours]. There was a significant association between right rotation repositioning error and concussion, with a 5% increase in concussion rate for each 10% increase in gross right rotation error (P = 0.021). CONCLUSION: Poor gross right rotation repositioning error is a modifiable intrinsic risk factor for concussion in professional male rugby players. Interventions to improve proprioceptive function may act as an effective method for reducing concussion incidence in this population.

National survey to evaluate musuloskeletal health in retired professional ballet dancers in the United Kingdom.

OBJECTIVES: To explore the musculoskeletal health of retired professional ballet dancers in the United Kingdom (UK). DESIGN: Online national survey. PARTICIPANTS: Retired professional ballet dancers living in the UK. METHODS: The survey explored: what musculoskeletal injuries or diseases are experienced by retired professional ballet dancers; which anatomical regions were affected by musculoskeletal injuries or diseases in retired professional ballet dancers; whether ballet dancers were forced to retire from professional ballet due to musculoskeletal injuries or disease. RESULTS: Forty-six retired ballet dancers responded. Thirty-six percent (n = 17) of respondents reported retiring from ballet due to musculoskeletal injury. The median age when respondents retired from professional ballet was 29 years. The most common issues that caused people to retire were hip and back pain (25%; n = 9 respectively), followed by hamstring injuries, ankle injuries, cervical spine injuries, and anterior knee pain (13% respectively; n = 5). Ninety-one percent (n = 42) reported experiencing muscle and joint pain post-retirement. CONCLUSIONS: Musculoskeletal pain and disease was a problem for respondents in this study. Further investigation is needed to define the problem, so management can be examined. Comparing performance and training regimes to injury rates in professional dancers, and then following these cohorts into retirement, would increase knowledge on this population.

Consensus statement: Oral health and elite sport performance.

While the research base is limited, studies have consistently reported poor oral health in elite athletes since the first report from the 1968 Olympic Games. The finding is consistent both across selected samples attending dental clinics at major competitions and more representative sampling of teams and has led to calls from the International Olympic Committee for more accurate data on oral health. Poor oral health is an important issue directly as it can cause pain, negative effects on appearance and psychosocial effects on confidence and quality of life and may have long-term consequences for treatment burden. Self-reported evidence also suggests an impact on training and performance of athletes. There are many potential challenges to the oral health of athletes including nutritional, oral dehydration, exercise-induced immune suppression, lack of awareness, negative health behaviours and lack of prioritisation. However, in theory, oral diseases are preventable by simple interventions with good evidence of efficacy. The consensus statement aims to raise awareness of the issues of oral health in elite sport and recommends strategies for prevention and health promotion in addition to future research strategies.

[Cystic tumours of the pancreas]. / Tumori cistici del pancreas.

The authors illustrate 2 cases of cystic pancreatic neoplasms recently observed at the 2nd Surgical Clinic of IRCCS Policlinico San Matteo in Pavia. Having emphasised the rarity of this pathology, they describe the specific nature of the clinical condition and symptoms which may remain unchanged for a long period. They then highlight the most significant radiological aspects, paying special attention to differential diagnosis. Surgery is indicated as the treatment of election, correlated to the topography of the lesion, the anatomic and histological nature of the disease, especially mucinous, and the patient s general conditions.

[Medullary thyroid carcinoma]. / Il carcinoma midollare della tiroide.

The authors report a case of medullary carcinoma of the thyroid diagnosed at the 2nd Surgery Clinic of IRCCS Policlinico "San Matteo" in Pavia in a series of 600 cases of thyroid pathology. Having emphasised the rarity of this pathology, the authors report the characteristic pathological aspects. They also outline the clinical signs leading to suspected diagnosis, illustrate the diagnostic techniques used to achieve an early diagnosis and underline the importance of the tumour markers CT and CEA. They identify radical surgery, total thyroidectomy with MND lymphadenectomy, as the therapy of choice, followed by accurate and careful monitoring with a view to ensuring an early diagnosis of renewed disease or recidivation.

[Prevalence and features of peptic ulcers in the elderly: a retrospective study on a not hospitalized population aged 65 or over]. / Caratteristiche e prevalenza dell'ulcera peptica nell'anziano: studio endoscopico retrospettivo su una coorte di pazienti ultrasessantacinquenni non istituzionalizzati.

BACKGROUND: The prevalence of peptic ulcer increases with aging. Data relative to peptic ulcer in the elderly are around 5.2% to 9.9%. The aim of the present study was to evaluate the prevalence and the features of peptic ulcer in a non hospitalized population aged 65 or over. METHODS: We performed, for the first time, EGDS on 706 patients with symptoms related to the superior gastroenteric tract. We considered the following risk factors: familiarity for peptic disease, habits, eventual use of FANS, infection of Hp. RESULTS: Our data show that peptic ulcer increases with aging and with physiopathological age-related changes. 114 (16.1%) patients were affected by DU; 84 (11.9%) patients were affected by GU Symptoms thereafter were not clear: epigastralgy was present in 46.4% of patients affected by GU; pyrosis, belchings, swellings, epigastric headness were present in 37.7% of patients with DU. Several times PU may arise with some complications: melena was present in 14.9% of patients with DU vs 11.9% of patients with GU, hematemesis was present in 1.7% of patients with DU vs 5.9% of patients with G.U. The most important risk factor was the infection of Hp, at was present in 71.9% patients with GU and 81.6% patients with DU FANS assumption, often with high dose, was present in 30.9% of patients with GU and 18.4% of patients with DU.

[Malignant fibrous histiocytoma of the breast. A clinical case]. / Istiocitoma fibroso maligno della mammella. Contributo clinico.

The authors report a personal, observed case of relapsing malignant fibrous histiocytoma of the breast. After recalling the anatomopathologic aspects and the clinical characteristics of the affection, the authors dwell upon the utility of correct diagnosis and point to the right therapeutic way consisting of a radical surgical treatment.

[Primary osteogenic sarcoma of the breast. Clinical contribution]. / Sarcoma osteogenico primitivo della mammella. Contributo clinico.

A case of primary osteogenic sarcoma of the breast is reported. All its clinical, radiological, gross and histological characteristics are analyzed, nevertheless the diagnosis is difficult. The authors dwell upon the utility of fine-needle aspiration and upon the importance of histologic and immunohistochemical studies. After emphasizing the difficulty both in an adequate local control and of metastasis, the authors point to the right therapeutic ways, still debated for the rarity of the tumor, which precludes every prospective trial.

[Intestinal occlusion caused by actinic ileitis]. / L'occlusione intestinale da ileite attinica.

During the 5-year period from 1988 to 1992, 6 patients underwent operation for radiation-induced small bowel obstruction at the General Surgery II, IRCCS Policlinico S. Matteo of Pavia. Based on this experience and reports in the literature, physiopathology, pathologic findings, and operative technics are discussed.

[Gastric injury by caustics: a case report]. / Su un caso di lesione gastrica isolata da caustici.

The authors get the idea from the observation of a case of ingestion of muriatic acid, recently happened by Clinical Surgery II of the IRCCS Polyclinic "San Matteo" of Pavia in order to examine carefully the matter. The rareness of the shown case is given by the whole involvement of only the stomach, without damages for the oropharynx and the esophagus. The total gastrectomy executed 6 months after the ingestion of the acid has given to the patient the whole recovery. The follow-up checked for a periodical time of 6 months for a period of about five years, permits to observe the normal intestinal canalization without stenitical symptoms or zonas with degenerative risk.

Low Prevalence of p-ANCA in Unaffected Relatives of Patients with Ulcerative Colitis from a Mediterranean Area.

: Antineutrophil-cytoplasmic-autoantibodies (p-ANCA) are strongly associated with ulcerative colitis (UC) and may represent an indicator of genetic susceptibility to UC. To further examine whether p-ANCA may serve as a genetic marker of UC we evaluated the frequency of p-ANCA in unaffected family members of UC from a defined geographic area. A total of 110 patients with UC and 90 unaffected family members (first- or second-degree relatives) were tested. Controls included: 58 Crohn's disease (CD) patients with 25 unaffected relatives and 52 irritable bowel syndrome (IBS) patients with 20 healthy family members. p-ANCA were detected by enzyme-linked immunoassay followed by immunofluorescence. p-ANCA were detected in 57 UC patients (51.8%). Six of 90 (6.6%) unaffected relatives were positive for p-ANCA and 4 of these were from two families. In 3 of 35 families the proband and at least one unaffected relative were p-ANCA-positive. In five families with more than one member affected by UC, p-ANCA were detected in 2 of 19 (10.5%) unaffected relatives. Six CD patients (10.3%) and one (1.9%) in the IBS group were positive for p-ANCA. One family member was positive in the CD family group and 1 was positive in the control family group. In the group of families recruited for this study, p-ANCA were not more frequent in unaffected relatives of UC patients than in controls, suggesting that at least in the geographic area considered for this study p-ANCA may not represent a definite subclinical marker of susceptibility for UC.

[Cervico-mediastinal goiters. Clinical aspects]. / I gozzi cervico-mediastinici. Contributo clinico.

Among 660 cases of thyroid pathology diagnosed by the 2nd Institute of Clinical Surgery, Policlinico San Matteo, IRCCS, Pavia, during the period 1984 to 1993, 34 cases of cervical-mediastinal goiter were observed with an incidence of 5%. After a careful analysis of the main contributions to the study of cervical-mediastinal goiters, paying special attention to their classification, pathogenesis, methods of growth, and unique symptomatic manifestations, the authors focus on current radiological and instrumental studies, which are widely regarded as being useful for the diagnosis of the site and nature of this disease. They review the routes for aggressive surgery and appropriate techniques for the exeresis of the mediastinal mass. Having empasised the absolute indication for surgery the authors recommend quasi-total or total thyroidectomy as the elective form of surgery.

[10 years of neoplastic pathology of the thyroid]. / Dieci anni di patologia neoplastica tiroidea.

Here the authors have reported case studies made over a ten year period from 1982 to 1991 at the Surgical Semeiology Institutes of the Surgical Pathology, and Surgery Clinic II of the IRCCS San Matteo General Hospital, Pavia. It considered 28 cases of thyroid carcinomas (18 papillary, 6 follicular, 3 anaplastic and 1 medullary). Firstly an in depth examination using the most up to date diagnostic methods available today was made with particular attention paid to cytological examination by needle suction showing the rarity of the affliction. Then the histological variables the various biological aggressiveness, the multicentric and bilateral nature of certain neoplastic forms were recorded. Finally particular attention was paid to the therapeutic problem. In agreement with the great majority of authors, they believe that the best therapy is as follows. For differentiated tumours, a total thyroidectomy and when there is a more conservative surgical choice, the isthmolobectomy should be modified by prognostic indicators (age, sex, six of the tumour, single or multi location histotype). Furthermore lymphadenectomy should not be carried out automatically, but after a careful evaluation of the lymph node areas for a simple suspicion of metastasis.

[Primary non-Hodgkin's lymphoma of the breast. Clinico-pathologic study of 2 cases]. / Linfomi non-Hodgkin primitivi della mammella. Studio clinico-patologico di due casi.

The authors describe two cases of malignant non-Hodgkin's lymphoma in a mammary site observed at IRCCS Policlinico San Matteo (Pavia). Histologic, immunohistochemical and clinical features are illustrated. Correct diagnosis is essential so that appropriate multidisciplinary treatment may be applied.

[Sigmoid volvulus]. / Considerazioni sul volvolo del sigma.

The authors report a retrospective study of four patients treated for sigmoid volvulus at the Clinica Chirurgica II of IRCCS Policlinico S. Matteo of Pavia between April 1974 and June 1989. They are collected from a series of 74 consecutive operations for colonic obstruction not related to hernias of the inguinal-crural region (incidence 5.4%). One patient died. The authors review the incidence, epidemiology, etiopathogenetic hypothesis, clinical patterns, nonoperative and operative therapeutic options of the affection. They emphasize the poor prognosis because the sigmoid volvulus usually occurs in elderly ill patients.

[Traumatic lesions of the colon]. / Considerazioni sulle lesioni traumatiche del colon.

Four patients operated on at the Clinica Chirurgica II of IRCCS--Policlinico San Matteo of Pavia for trauma involving the colon were reviewed. All were males and their ages ranged from 14 to 84 years (mean 43.5 years). Injuries of the colon were found on 9 per cent of all patients operated on for abdominal penetrating injuries and on 6 per cent of patients with blunt injuries. The authors recall the pathogenetic mechanisms, clinical patterns, some grading systems proposed for quantifying the severity of the lesion. Our experience has shown that in blunt trauma the prognosis is worse because there were many associated organ injuries. These condition the early mortality for shock and exsanguination.

[Acute pseudo-obstruction of the colon (clinical cases)]. / La pseudo-ostruzione acuta del colon (contributo casistico).

The Authors report 4 cases of Ogilvie's syndrome come to their observation during the last 5 years by the clinical surgery II of the I.R.C.C.S. Polyclinic "San Matteo" of Pavia. Remembering the infrequency of the affection and the controversial etiopathogenesis theories, the Authors study the clinical picture and the diagnostic problems, pointing out how some researches, especially radiological and endoscopical, permit to obtain a therapeutic solution of the syndrome. They underline the colonic perforation risk, certainly overestimated, and they show the therapeutic, medical or surgical, orientations, according to the evolution of the illness, the anatomic situations and the general conditions of the patient.