Carotid artery dissection after treadmill running.
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The case is presented of carotid artery dissection causing Horner's syndrome in a 25 year old woman after treadmill running. She presented with characteristic eye signs and mild pain. Early diagnosis and treatment was associated with no long term, serious complications. It is now recognised that carotid artery dissection is more common than previously thought. Better imaging of the carotid artery has facilitated the diagnosis, and it is now essential to rule out this potentially fatal condition in patients presenting with postganglionic Horner's syndrome. It is accepted that relatively trivial trauma can cause a carotid artery dissection, and many sporting activities may place young, fit, healthy people at risk. (+info)
Soft tissue neck lumps in rugby union players.
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Dorsal neck masses are well recognised in front row rugby union players. Previously undescribed in the medical literature, they may present in the primary or secondary care setting when they become symptomatic. Often misdiagnosed as lipomata, they may in fact be fibrous and deeply connected, with the consequences of embarking on surgery subsequently underestimated. This paper describes an epidemiological study using the rugby union media and gives key points for healthcare professionals involved in the management of such masses. (+info)
Mechanical traction for mechanical neck disorders: a systematic review.
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OBJECTIVE: To assess whether mechanical traction, either alone or in combination with other treatments, improves pain, function/disability, patient satisfaction and global perceived effect in adults with mechanical neck disorders. METHODS: We conducted a systematic review up to September 2004 of randomized controlled trials and used pre-defined levels of evidence for qualitative analysis. Two independent reviewers conducted study selection, data abstraction and methodological quality assessment. Using a random effects model, relative risk and standardized mean differences were calculated. The reasonableness of combining studies was assessed on clinical and statistical grounds. In the absence of heterogeneity, pooled effect measures were calculated. RESULTS: Of the 10 selected trials, one study was of high quality. Our review revealed low-quality trials for mechanical neck disorders, showing evidence of benefit favouring intermittent traction for pain reduction. Continuous traction showed no significant difference for defined outcomes. CONCLUSION: Inconclusive evidence for continuous and intermittent traction exists due to trial methodological quality. Two clinical conclusions may be drawn, one favouring the use of intermittent traction and the other not supporting the use of continuous traction. Attention to research design flaws and description of traction characteristics is needed. (+info)
Prospective research on musculoskeletal disorders in office workers (PROMO): study protocol.
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BACKGROUND: This article describes the background and study design of the PROMO study (Prospective Research on Musculoskeletal disorders in Office workers). Few longitudinal studies have been performed to investigate the risk factors responsible for the incidence of hand, arm, shoulder and neck symptoms among office workers, given the observation that a large group of office workers might be at risk worldwide. Therefore, the PROMO study was designed. The main aim is to quantify the contribution of exposure to occupational computer use to the incidence of hand, arm, shoulder and neck symptoms. The results of this study might lead to more effective and/or cost-efficient preventive interventions among office workers. METHODS/DESIGN: A prospective cohort study is conducted, with a follow-up of 24 months. In total, 1821 participants filled out the first questionnaire (response rate of 74%). Data on exposure and outcome is collected using web-based self-reports. Outcome assessment takes place every three months during the follow-up period. Data on computer use are collected at baseline and continuously during follow-up using a software program. DISCUSSION: The advantages of the PROMO study include the long follow-up period, the repeated measurement of both exposure and outcome, and the objective measurement of the duration of computer use. In the PROMO study, hypotheses stemming from lab-based and field-based research will be investigated. (+info)
Delayed evaluation of combat-related penetrating neck trauma.
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OBJECTIVE: The approach to penetrating trauma of the head and neck has undergone significant evolution and offers unique challenges during wartime. Military munitions produce complex injury patterns that challenge conventional diagnosis and management. Mass casualties may not allow for routine exploration of all stable cervical blast injuries. The objective of this study was to review the delayed evaluation of combat-related penetrating neck trauma in patients after evacuation to the United States. METHOD: From February 2003 through April 2005, a series of patients with military-associated penetrating cervical trauma were evacuated to a single institution, prospectively entered into a database, and retrospectively reviewed. RESULTS: Suspected vascular injury from penetrating neck trauma occurred in 63 patients. Injuries were to zone II in 33%, zone III in 33%, and zone I in 11%. The remaining injuries involved multiple zones, including the lower face or posterior neck. Explosive devices wounded 50 patients (79%), 13 (21%) had high-velocity gunshot wounds, and 19 (30%) had associated intracranial or cervical spine injury. Of the 39 patients (62%) who underwent emergent neck exploration in Iraq or Afghanistan, 21 had 24 injuries requiring ligation (18), vein interposition or primary repair (4), polytetrafluoroethylene (PTFE) graft interposition (1), or patch angioplasty (1). Injuries occurred to the carotid, vertebral, or innominate arteries, or the jugular vein. After evacuation to the United States, all patients underwent radiologic evaluation of the head and neck vasculature. Computed tomography angiography was performed in 45 patients (71%), including six zone II injuries without prior exploration. Forty (63%) underwent diagnostic arteriography that detected pseudoaneurysms (5) or occlusions (8) of the carotid and vertebral arteries. No occult venous injuries were noted. Delayed evaluation resulted in the detection of 12 additional occult injuries and one graft thrombosis in 11 patients. Management included observation (5), vein or PTFE graft repair (3), coil embolization (2), or ligation (1). CONCLUSIONS: Penetrating multiple fragment injury to the head and neck is common during wartime. Computed tomography angiography is useful in the delayed evaluation of stable patients, but retained fragments produce suboptimal imaging in the zone of injury. Arteriography remains the imaging study of choice to evaluate for cervical vascular trauma, and its use should be liberalized for combat injuries. Stable injuries may not require immediate neck exploration; however, the high prevalence of occult injuries discovered in this review underscores the need for a complete re-evaluation upon return to the United States. (+info)
Trends in suicide in a Lithuanian urban population over the period 1984-2003.
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BACKGROUND: Throughout the last decade of the twentieth century, Lithuania had the highest suicide rates in Europe among both men and women aged 25-64 years. The rates increased from 1986 until 1995, but later there was a slight decrease. This paper describes the trends in suicide deaths in urban population in Lithuania by gender, dates and suicide method over the period 1984-2003. METHODS: Data from the regional mortality register were used to analyze suicide deaths among all men and women aged 25-64 years in Kaunas city, Lithuania over the period 1984-2003. Age-standardized death rates per 100,000 persons (using European standard population) were calculated by gender, suicide method and dates. A joinpoint regression method was used to estimate annual percentage changes (EPACs) and to detect points where the trends changed significantly. RESULTS: The frequency of death by suicide among males was 48% higher in 1994-2003 than in 1984-1993. The corresponding increase among females was 28%. The most common methods of suicide among men were hanging, strangulation and suffocation (87.4% among all suicide deaths). The proportions of hanging, strangulation and suffocation in males increased by 6.9% - from 83.9% to 89.7% - compared to a 24.2% increase in deaths from handgun, rifle and shotgun firearm discharges and a 216.7% increase in deaths from poisoning with solvents, gases, pesticides and vapors. Among females, the most common methods of suicide were hanging, strangulation and suffocation (68.3% of all suicide deaths). The proportion of hanging deaths among females increased during the time period examined, whereas the proportion of poisonings with solid or liquid substances decreased. CONCLUSION: Suicide rates increased significantly among urban men aged 25-64 years in Lithuania throughout the period 1984-2003, whereas among women an increasing but statistically insignificant trend was observed. There were changes in the suicide methods used by both men and women. Changes in the choice of method may have contributed to the changes in suicide rates. (+info)
Retropharyngeal haemorrhage from a vertebral artery branch treated with distal flow arrest and particle embolisation.
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Retropharyngeal haematoma is a rare cause of rapid neck swelling that may result in fatal upper respiratory airway obstruction. Reported causes include trauma, surgery, retropharyngeal inflammation, carotid aneurysm, aberrant artery at the thoracic inlet and bleeding diathesis. We report a 90-year-old man who developed rapid and progressive neck swelling following a minor traumatic episode. Computed tomography showed a large low-density retropharyngeal haematoma extending from the skull base to the mediastinum, with suspected extravasation. The right vertebral artery angiogram confirmed contrast agent extravasation arising from a small branch artery. This was treated with temporary distal flow arrest and particle embolisation. (+info)
Shopping-cart-related injuries to children.
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An estimated 24,200 children younger than 15 years, 20,700 (85%) of whom were younger than 5 years, were treated in US hospital emergency departments in 2005 for shopping cart-related injuries. Approximately 4% of shopping cart-related injuries to children younger than 15 years require admission to the hospital. Injuries to the head and neck represent three fourths of all injuries. Fractures account for 45% of all hospitalizations. Deaths have occurred from falls from shopping carts and cart tip-overs. Falls are the most common mechanism of injury and account for more than half of injuries associated with shopping carts. Cart tip-overs are the second most common mechanism, responsible for up to one fourth of injuries and almost 40% of shopping cart-related injuries among children younger than 2 years. Public-awareness initiatives, education programs, and parental supervision, although important, are not enough to prevent these injuries effectively. European Standard EN 1929-1:1998 and joint Australian/New Zealand Standard AS/NZS 3847.1:1999 specify requirements for the construction, performance, testing, and safety of shopping carts and have been implemented as national standards in 21 countries. A US performance standard for shopping carts (ASTM [American Society for Testing and Materials] F2372-04) was established in July 2004; however, it does not adequately address falls and cart tip-overs, which are the leading mechanisms of shopping cart-related injuries to children. The current US standard for shopping carts should be revised to include clear and effective performance criteria for shopping cart child-restraint systems and cart stability to prevent falls from carts and cart tip-overs. This is imperative to decrease the number and severity of shopping cart-related injuries to children. Recommendations from the American Academy of Pediatrics regarding prevention of shopping cart-related injuries are included in the accompanying policy statement. (+info)