RESUMEN

OBJECTIVE: To present the case of 2 adolescent high school student-athletes who developed postconcussion syndrome with protracted and limiting visual complaints that markedly affected academic, social, and athletic activity for a year after the onset of symptoms. Both had significant improvement soon after a unique intervention was administered. BACKGROUND: A 14-year-old female soccer and softball player sustained 2 concussions in the same week. She had persistent symptoms for a year that affected her grades and precluded athletic participation. A 15-year-old male football player sustained a concussion during an altercation with 2 other male adolescents. He continued to have symptoms 1 year later, with a marked decrease in academic performance and restriction from athletics. Both adolescents reported blurry vision, photophobia, and associated headache as significant components of the postconcussion syndrome. DIFFERENTIAL DIAGNOSIS: Concussion, postconcussion syndrome, skull fracture, subdural hematoma, epidural hematoma, second-impact syndrome, and visually sensitive migraine. TREATMENT: Both patients were advised to obtain computer gaming glasses to use throughout the day. The female patient was diligent in her use of the glasses, with marked lessening of symptoms. The male patient was less accepting of the glasses but did report lessening of symptoms when using the glasses. UNIQUENESS: We hypothesized that postconcussion syndrome with marked visual complaints would respond to and improve with decreased stimulation of the visual system. This was attempted with the addition of computer gaming glasses. Both adolescent athletes responded well to the filtering of visual stimuli by off-the-shelf computer gaming glasses. CONCLUSIONS: Postconcussion syndrome is a persistent condition with a myriad of symptoms. Two young athletes developed postconcussion syndrome with prominent visual symptoms that lasted a year. The addition of computer gaming glasses markedly lessened symptoms in both patients.

Asunto(s)

Traumatismos en Atletas/complicaciones , Conmoción Encefálica/complicaciones , Dispositivos de Protección de los Ojos , Síndrome Posconmocional , Trastornos de la Visión , Adolescente , Atletas , Rendimiento Atlético , Béisbol/lesiones , Diagnóstico Diferencial , Evaluación Educacional , Femenino , Fútbol Americano/lesiones , Humanos , Masculino , Estimulación Luminosa/efectos adversos , Síndrome Posconmocional/diagnóstico , Síndrome Posconmocional/etiología , Síndrome Posconmocional/fisiopatología , Síndrome Posconmocional/rehabilitación , Fútbol/lesiones , Resultado del Tratamiento , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/etiología , Trastornos de la Visión/prevención & control

RESUMEN

Diagnosis of upper extremity injuries depends on knowledge of basic anatomy and biomechanics of the hand and wrist. The wrist is composed of two rows of carpal bones. Flexor and extensor tendons cross the wrist to allow function of the hand and digits. The ulnar, median, and radial nerves provide innervation of the hand and wrist. A systematic primary and secondary examination of the hand and wrist includes assessment of active and passive range of motion of the wrist and digits, and dynamic stability testing. The most commonly fractured bone of the wrist is the scaphoid, and the most common ligamentous instability involves the scaphoid and lunate.

Asunto(s)

Traumatismos de la Mano/diagnóstico , Mano/anatomía & histología , Traumatismos de la Muñeca/diagnóstico , Mano/inervación , Traumatismos de la Mano/patología , Humanos , Ligamentos/anatomía & histología , Examen Físico , Tendones/anatomía & histología , Traumatismos de la Muñeca/patología

RESUMEN

Primary care physicians must be able to recognize wrist and hand injuries that require immediate attention. A complete history and physical examination, including assessment of distal limb function, are essential. Hemorrhage control is necessary in patients with vessel lacerations and amputations. Amputations require an understanding of the indications and contraindications in the management of the amputated limb. High-pressure injection injuries and compartment syndromes require a high index of suspicion for early recognition. Infectious entities include "fight bite," open fractures, purulent tenosynovitis, animal bites, and retained foreign bodies. Tendon disruptions should be recognized early to optimize management.

Asunto(s)

Traumatismos de la Mano/diagnóstico , Traumatismos de la Muñeca/diagnóstico , Amputación Traumática/terapia , Profilaxis Antibiótica , Mordeduras Humanas/terapia , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/etiología , Servicios Médicos de Urgencia , Fracturas Óseas/terapia , Traumatismos de la Mano/complicaciones , Traumatismos de la Mano/terapia , Humanos , Examen Físico , Traumatismos de los Tendones/terapia , Tétanos/prevención & control , Traumatismos de la Muñeca/complicaciones , Traumatismos de la Muñeca/terapia

RESUMEN

A kinetic method to measure the intracellular concentration of respiratory substrates in short-term starvation-enrichment experiments is proposed. Samples of bacterial suspension from steady-state chemostat cultures were subjected to 25 min starvation, followed by pulse addition of [14C]glucose. Residual substrate utilization rates and respiration rates (uptake of dissolved O2) before and after amendment were recorded. Increases in pool sizes (δL) during transients were calculated on the basis of C balance. The dependence of respiration rate qresp on δL was found to obey modified Michaelis-Menten kinetics: q resp = Q resp (LC+δL)/(K L+LC+δL) [Q resp is maximal respiration rate (29.1 mmol O2 h-1per g biomass C), K L = 12.14 mg C per g biomass C], where LC is the absolute value of the pool size before amendment. Direct chemical determination of LC in cold TCA extracts revealed two fractions. The first fraction was mobile and showed a close correlation with both respiration and L. The second, 'stable', fraction did not correlate with respiration dynamics and was interpreted as material formed artifactually by acid degradation of polymeric cell components.