1/9. Cervical spine injuries in the athlete.Special considerations must be brought into play when the physician is consulted about when to allow an athlete to return to play following injury. This is especially true for brain and spinal cord injury. Although it is generally best to be on the conservative side, being too reticent about allowing any athlete to return may be very detrimental to the athlete and/or the entire team. Therefore, it behooves the sports physician to be circumspect with regard to not only the type of injury the athlete has suffered but also the nature, duration, and the repetitive aspects of the trauma along with the inherent strengths of any player. This article will provide the sports physician with criteria for making sound decisions regarding return to competition after cervical spine injury and "functional" cervical spinal stenosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. Occult ligamentous injury of the cervical spine.Evaluating the cervical spine for injury is an essential part of the assessment of a traumatized patient. Clinical examination and radiographs are the traditional techniques used for this evaluation. Often, however, a reliable clinical examination is not possible because of head injury, altered mental status, or "distracting" injuries. In such cases, cervical spine injury that is not apparent on radiographs may be missed. This case report illustrates a purely ligamentous cervical spine injury resulting in cervical instability. We describe our method of screening for and evaluating these types of injuries using physician-controlled stretch, flexion, and extension examination under fluoroscopy.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
3/9. Seat belt syndrome in children: a case report and review of the literature.Characteristic patterns of injury to children in automobile crashes resulting from lap and lap-shoulder belts have been described for many years. These injuries are known as the "seat belt syndrome." We present a typical case of seat belt syndrome involving a 4-year-old boy and review the current literature on the topic, highlighting proposed mechanisms of intra-abdominal and spine injuries. In addition, recent research findings identifying a new pattern of injuries associated with inappropriate seat belt use in young children are reviewed. Emergency physicians must consider these seat belt-related injuries in the initial evaluation of any child involved in a motor vehicle crash who was restrained with the vehicle seat belt.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
4/9. Posttraumatic total dislocation of the upper thoracic spine.BACKGROUND: Difficulty in proper visualization of the upper thoracic spine in plain radiographs allows for injuries at this level to be missed, especially in a busy trauma center. This window of error is increased when the patient presents with no symptoms or signs of neurologic or spinal involvement, as upper thoracic dislocations commonly present early. CASE DESCRIPTION: The authors report a 19-year-old girl who developed progressive paraparesis 18 hours following initial presentation with a scalp avulsion injury. Imaging revealed a complete dislocation at T1-T2, with cord compression. Emergency surgical decompression and reconstruction of her spinal column was performed with a 360-degree stabilization. There was immediate neurologic improvement and on follow-up the patient is neurologically normal. CONCLUSIONS: The case highlights the difficulty in visualization of the upper thoracic spine in routine radiographs taken in a casualty setting. Treating physicians should have a low threshold for investigation of cervico-thoracic dislocations. The possibility of a delayed progressive dislocation should be kept in mind when dealing with injuries with a potential for spinal injury.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
5/9. osteoporosis and asthma.OBJECTIVE: To summarize the etiology, evaluation, prevention, and management of osteoporosis in a patient with asthma and worsening osteoporosis, a problem that is frequently encountered in an allergy-immunology practice, and the incidence, risk factors, screening guidelines, and recommended prevention and treatment options for this disease. DATA SOURCES: medline was searched for relevant English-language review articles published between January 1993 and March 2006 using the keyword osteoporosis in combination with asthma or COPD (chronic obstructive pulmonary disease). Additional sources and studies cited include relevant references from the official guidelines of the national medical associations, including the National osteoporosis Foundation, the American College of rheumatology, the world health organization, and the National Institutes of Health consensus Development Panel on osteoporosis Prevention, diagnosis, and Therapy. STUDY SELECTION: The authors selected the most relevant and recent sources for inclusion in this review. RESULTS: As the population ages, osteoporosis continues to increase in prevalence and severity. Screening rates of patients at risk of osteoporosis are suboptimal. A variety of effective treatment options are available for osteoporosis prevention and therapy. CONCLUSION: patients with asthma and chronic obstructive pulmonary disease are at risk of osteoporosis, especially those patients who are treated with high doses of corticosteroids. Specialist physicians should be knowledgeable about the screening guidelines, counseling, and therapeutic options for the prevention and management of osteoporosis.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
6/9. Surgical stabilization of pathological neoplastic fractures.The most important factor to consider in deciding between treatment options in the management of metastatic bone disease is the level of the patient's dysfunction and pain. Severe dysfunction or pain demands a treatment that predictably leads to a quick resumption of the painless activities of daily living. A treatment that predictably will restore function in months may seem reasonable in patients with a normal remaining life span, but is untenable if those months represent a high percentage of remaining life span, as they do in metastatic disease afflicted patients. The treating physician needs also to understand the basis for the patient's dysfunction. A destroyed joint will not return to painless function even if the metastasis responsible is totally eliminated. A bone that has lost its structural integrity, even though not grossly fractured, will not support weight bearing for months even if the metastasis is eliminated. Control of the metastatic tumor does not always equate with return to function. Treatment options in the management of metastatic bone disease are not mutually exclusive. In many patients treatment options are combined. Surgical stabilization may best return the patient's function while he is being treated postoperatively with radiotherapy or chemotherapy for good neoplasm control. Neoplasm control should not be such an overriding concern that function is not addressed. Function can almost always be returned to the patient, but neoplasm "cure" is rarely achieved in this group of patients. It is a reasonable goal to avoid allowing bone metastasis to progress to pathological fracture. Routine periodic examinations and bone scans should commonly alert the treating physician to the presence of metastatic bone disease well before fracture occurs. Pathological fracture narrows the range of treatment options, mitigates against full functional restoration, demands a rehabilitation hiatus, and acutely frightens the patient who does not have time to participate fully in treatment decisions. An impending pathological fracture can be treated with surgery, radiotherapy, chemotherapy, or hormonal manipulation. The options are basically operative or nonoperative. Lesions that predictably will fracture short term, involve joints, or will cause catastrophic consequences if fracture occurs should be strongly considered for surgical stabilization. Other factors to consider are the location of the metastasis, the primary tumor, and the expected response to nonoperative therapy. The patient becomes a surgical candidate for the above reasons and not because of any estimated life span.(ABSTRACT TRUNCATED AT 400 WORDS)- - - - - - - - - - ranking = 0.66666666666667keywords = physician (Clic here for more details about this article) |
7/9. spine problems in emergency department patients: does every patient need an x-ray?Two hundred adults with spine problems were evaluated by one examiner in a community hospital emergency department. A patient was considered to have a spine problem requiring evaluation if presenting with pain in the neck or back not obviously caused by a process outside of the spine (eg, back pain in a patient with renal colic); if there was known or suspected trauma to the neck or back; or if the clinical setting suggested spinal tumor, infection, metabolic bone disease, or ankylosing spondylitis. Of the 200 patients, 143 were studied by x-ray films. Six patients (6 of 143, or 4%) had x-ray abnormalities that mandated specific treatment. Fifty-two of the 57 patients not receiving x-ray studies were followed up at 2 months. Thirty-three of these patients (63%) had no x-ray studies in the interim and had improved greatly. Nineteen (37%) had been studied radiographically in the interim, but no abnormality requiring specific treatment was found in any patient. Emergency physicians should be aware that x-ray studies of the spine have low utility for patients whose histories and examinations are benign, that especially for women lumbosacral x-ray studies involve high gonadal radiation exposure, and that selected patients can be managed without x-ray studies and still be satisfied recipients of adequate medical care.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
8/9. Computed tomographic scanning and the lumbar spine. Part II: Clinical considerations.With the advent of computed tomography of the lumbar spine, the theories of a small number of pioneering physicians regarding the pathologic sequela of degenerative disc disease and the entities of central and lateral spinal stenosis have been translated into objective determinations which can now be observed by all. CT scanning has provided clinicians with a better appreciation of the diagnostic limitations of myelography and of the pathologic sequela of hemilaminectomy, dorsal-lateral fusion, and discectomy itself. Since the identification by CT scanning of the loss of disc volume, leading to lateral nerve entrapment and nerve compression resulting from fusion overgrowth, it has become clear that our present modes of therapy require comprehensive reevaluation. Because of the findings of CT scanning, dorsal-lateral fusion now appears to have a much reduced role in the treatment of degenerative disc disease and spinal stenosis. In an era in which unnecessary surgery is a matter of concern, CT scanning is an important means of ensuring that surgery will be undertaken only after thorough pathologic conditions.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
9/9. The perils of bungee jumping.Bungee jumping is a relatively new recreational sport. Most emergency physicians and trauma surgeons have limited experience with its associated injuries. We report the case of a bungee cord attachment apparatus malfunctioning, resulting in a free fall of the jumper of approximately 240 feet. The presence of an air cushion on the ground prevented significant injury. knowledge of the potential injuries of this new sport is crucial for effective management.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |