Search

[Objectives] To explore the effects of Shentong Zhuyu decoction combined with massage therapy in the treatment of exertional chronic lumbar muscle strain. [Methods] Sixty-four cases of exertional chronic lumbar muscle strain were randomly divided into two groups (32 cases each group). The patients in the control group only took celecoxib capsules, and those in the treatment group additionally took Shentong Zhuyu decoction combined with massage therapy. TCM syndrome score, lumbar function, hemorrheology index and clinical effect were compared between the two groups before and after treatment. [Results] After treatment, the TCM syndrome scores of lumbar distension/dull pain, tingling-like lumbago, adverse lateral turn, body weight loss, dark purple tongue, slow or astringent pulse, and Oswestry disability index (ODI) score in the treatment group were lower than those in the control group, and the levels of plasma viscosity, red blood cell aggregation index, platelet aggregation rate ( PAG) and fibrinogen (Fib) were lower than those in the control group, showing statistical significance (P < 0.05). The overall clinical effect distribution of the treatment group was better than that of the control group, and the difference was statistically significant (P<0.05). [Conclusions] Shentong Zhuyu decoction combined with massage therapy can effectively relieve the symptoms of patients with lumbago and improve the lumbar mobility function and hemorrheology, with obvious therapeutic effects in the treatment of exertional chronic lumbar muscle strain. [ABSTRACT FROM AUTHOR]

Utilizing metadata from existing exertional and exertional-heat stress studies, the study aimed to determine if the exercise-associated increase in core body temperature can predict the change in exercise-induced gastrointestinal syndrome (EIGS) biomarkers and exercise-associated gastrointestinal symptoms (Ex-GIS). Endurance-trained individuals completed 2 h of running exercise in temperate (21.2-30.0°C) to hot (35.0-37.2°C) ambient conditions (n = 132 trials). Blood samples were collected pre- and post-exercise to determine the change in gastrointestinal integrity biomarkers and systemic inflammatory cytokines. Physiological and thermoregulatory strain variables were assessed every 10–15 min during exercise. The strength of the linear relationship between maximal (M-Tre) and change (Δ Tre) in rectal temperature and EIGS variables was determined via Spearman's rank correlation coefficients. While the strength of prediction was determined via simple and multiple linear regression analyses dependent on screened EIGS and Ex-GIS confounding factors. Significant positive correlations between Tre maximum (M-Tre) and change (Δ Tre) with I-FABP (rs = 0.434, p < 0.001; and rs = 0.305, p < 0.001; respectively), sCD14 (rs = 0.358, p < 0.001; and rs = 0.362, p < 0.001), systemic inflammatory response profile (SIR-Profile) (p < 0.001), and total Ex-GIS (p < 0.05) were observed. M-Tre and Δ Tre significantly predicted (adjusted R2) magnitude of change in I-FABP (R2(2,123)=0.164, p < 0.001; and R2(2,119)=0.058, p = 0.011; respectively), sCD14 (R2(2,81)=0.249, p < 0.001; and R2(2,77)=0.214, p < 0.001), SIR-Profile (p < 0.001), and total Ex-GIS (p < 0.05). Strong to weak correlations were observed between M-Tre and Δ Tre with plasma concentrations of I-FABP, sCD14, SIR-Profile, and Ex-GIS in response to exercise. M-Tre and Δ Tre can predict the magnitude of these EIGS variables and Ex-GIS in response to exercise. [ABSTRACT FROM AUTHOR]

Copyright of Sport-Orthopadie - Sport-Traumatologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Exertional rhabdomyolysis results from a breakdown of skeletal muscle cells after intense exercise in otherwise healthy patients, causing increased levels of creatine kinase (CK) or myoglobin, as well as urine dipstick positive for blood, and may result in kidney insufficiency. The aim of this study was to outline the current perspectives of exertional rhabdomyolysis in athletes and subsequent treatment based on the current literature. Data Sources: We searched the MEDLINE/PubMed and Google databases for ([exercise] OR [exertional]) AND rhabdomyolysis following the PRISMA guidelines. All abstracts were reviewed by 2 independent examiners. Inclusion criteria consisted of original articles presenting studies on exertional rhabdomyolysis or exercise-induced rhabdomyolysis with 7 or more cases. All case reports, case series, or editorials were excluded. Main Results: A total of 1541-abstracts were screened, leaving 25 studies for final inclusion and analysing 772patients. Especially, young male patients were affected at a mean age of 28.7 years (range 15.8-46.6 years). Most of the athletes performed running, including marathons in 54.3% of cases (n = 419/772), followed by weightlifting in 14.8% (n = 114/772). At the time of presentation, the mean creatine kinase was 31 481 IU/L (range 164-106,488 IU/L). Seventeen studies reported the highest level of CK, which was 38 552 IU/L (range 450-88,496 IU/L). For treatment, hydration was the most common method of choice reported by 8 studies. Conclusions: Exertional rhabdomyolysis seems to be underestimated, and it is essential to screen patients who present with muscle soreness/cramps and/or dark urine after heavy endurance events to avoid any further complications. Level of Evidence: II; systematic review. [ABSTRACT FROM AUTHOR]

• The Dyspnea Challenge is reliable in heart failure. • The Dyspnea Challenge is reliable in COPD. • The Dyspnea Challenge can differentiate between pathophysiology. In heart failure (HF), exertional dyspnea is a common symptom, but validated field-based tests for its measurement are limited. The Dyspnea Challenge is a two-minute uphill treadmill walk designed to measure exertional dyspnea in cardiopulmonary disease. The purpose of this study was to establish the test-retest reliability of the Dyspnea Challenge in HF and to compare the exercise responses to a group with chronic obstructive pulmonary disease (COPD). The study was an experimental, single-blind, randomized, multi-site project that recruited individuals with HF (New York Heart Association I-III) and COPD (Global Initiative for Chronic Obstructive Lung Disease II-IV). Participants completed two visits. On the first visit, participants performed two six-minute walk tests (6MWT), followed by two to three Dyspnea Challenges to calculate treadmill speed and gradient. At Visit Two, participants performed two separate Dyspnea Challenges, with one including measures of pulmonary gas exchange and central hemodynamics. Twenty-one individuals with HF (10 female; 66±11years; ejection fraction:45.3 ± 6.1%; six-minute distance(6MWD) 520 ± 97 m), and 25 COPD (11 female; 68 ± 10 yr; forced expiratory volume in 1 s:47.6 ± 11.5%; 6MWD: 430 ± 101 m). Intraclass correlation coefficients demonstrated excellent test-retest reliability for HF (0.94, P <.01) and COPD (0.95, P <.01). While achieving similar end-exercise exertional dyspnea intensities (P =.60), the HF group walked at a higher average speed (4.2 ± 0.8 vs. 3.5 ± 0.8km·h−1) and gradient (10.3 ± 2.8 vs. 9.6 ± 2.8%) and a greater oxygen uptake (P <.01) and ventilation (P <.01) than those with COPD. While achieving similar cardiac outputs (P =.98), stroke volumes (P =.97), and heart rates (P =.83), those with HF displayed a larger arteriovenous oxygen difference (P <.01), while those with COPD exhibited greater decreases in inspiratory capacity (P=.03), arterial oxygen saturation (P=.02), and breathing reserve (P<.01). The Dyspnea Challenge is a reliable test-retest measure of exertional dyspnea in HF. Typical to their pathologies, HF seemed limited by an inadequate modulation of cardiac output, while ventilatory constraints hampered those with COPD. [ABSTRACT FROM AUTHOR]

Considering the recent growth of exercise gastroenterology research focusing on exercise-induced gastrointestinal syndrome mechanisms, response magnitude, prevention and management strategies, the standardized assessment of gastrointestinal symptoms (GIS) is warranted. The current methodological study aimed to test the reliability of a modified visual analog scale for assessing GIS during exercise, in response to a variety of exertional-stress scenarios, with and without dietary intervention. Recreational endurance runners (n = 31) performed one of the three exercise protocols, which included: 2-hr running at 70% VO2max in temperate (24.7 °C) ambient conditions, with fluid restriction; 2-hr running at 60% VO2max in hot (35.1 °C) ambient conditions, while consuming chilled water immediately before and every 15 min during exercise; and 2-hr running at 60% VO2max in temperate (23.0 °C) ambient conditions, while consuming 30 g/20 min carbohydrate (2:1 glucose:fructose, 10% temperate w/v), followed by a 1-hr distance test. GIS was monitored pre-exercise, periodically during exercise, and immediately postexercise. After wash out, participants were retested in mirrored conditions. No significant differences (p > .05) were identified between test-retest using Wilcoxon signed-rank test for all GIS (specific and categorized), within each exercise protocol and the combined protocols. Strong correlations were observed for gut discomfort, total GIS, upper GIS, and nausea (rs = .566 to rs = .686; p < .001), but not for lower GIS (rs = .204; p = .232). Cohen's magnitude of difference was minimal for all GIS (specific δ < 0.14 and categorized δ < 0.08). The modified visual analog scale for assessing GIS during exercise appears to be a reliable tool for identifying incidence and severity of GIS in cohort populations and is sensitive enough to detect exertional and intervention differences. [ABSTRACT FROM AUTHOR]

Introduction: Spinning is an indoor stationary cycling programme that can cause severe rhabdomyolysis. We compared the clinical characteristics of spinning-induced exertional rhabdomyolysis (SER) with other exertional rhabdomyolysis (ER) and non-exertional rhabdomyolysis (NER).Methods: This was a retrospective observational study of adult patients presenting with rhabdomyolysis to an emergency department from August 2018 to August 2019. Patients were classified as SER, ER or NER based on chart review. We compared patient demographics, serum creatine kinase (CK), transaminase and creatinine levels, admission rates, duration of hospitalisation and treatment prescribed.Results: 62 patients were analysed. SER patients were predominantly female (77% vs. 24% vs. 26%, P < 0.01), Chinese (100% vs. 47% vs. 79%, P < 0.01) and younger (mean age 27.7 vs. 34.6 vs. 59.4 years, P < 0.01) than those with ER and NER. The SER group had the highest CK level (20,000 vs. 10,465 vs. 6,007 U/L, P < 0.01) but the lowest mean serum creatinine level (53.5 vs. 80.9 vs. 143.5 μmol/L, P < 0.01) compared to the ER and NER groups. Admission rates were the highest in SER patients (100% vs. 57% vs. 90%, P < 0.01). SER mean inpatient length of stay was longer than ER but shorter than NER patients (4.3 vs. 1.9 vs. 6.0 days, P = 0.02).Conclusion: SER is a unique form of rhabdomyolysis. Predominantly seen in young, healthy women, it often presents with extremely high CK levels. However, the prognosis is good and the rate of complication is low with fluid treatment. [ABSTRACT FROM AUTHOR]

Shuyuan Liu,1,2,&ast; Ling Xing,1,3,&ast; Qian Wang,4 Tianyu Xin,2 Handing Mao,1 Ye Tao,5 Jinbao Zhao,2 Xin Li,4 Cong Li,1 Qinghua Li,6 Yan Dou,7 Yixin Li,8 Wei Zhang,9 Bo Ning,10 Qing Song1 1Medical School of Chinese PLA, Beijing, People’s Republic of China; 2Emergency Department, Sixth Medical Center, Chinese PLA General Hospital, Beijing, People’s Republic of China; 3Department of Emergency, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China; 4Emergency Department, Third Medical Center, Chinese PLA General Hospital, Beijing, People’s Republic of China; 5Health Care Department, Beijing Huangsi Aesthetic Surgery Hospital, Beijing, People’s Republic of China; 6Department of Intensive Care Unit, The 990th Hospital of Chinese PLA, Zhumadian, People’s Republic of China; 7Department of Intensive Care Unit, The 909th Hospital of Chinese PLA, Zhangzhou, People’s Republic of China; 8Department of Intensive Care Unit, The 910th Hospital of Chinese PLA, Quanzhou, People’s Republic of China; 9Emergency Department, The 900th Hospital of Chinese PLA, Fuzhou, People’s Republic of China; 10Department of Intensive Care Unit, Air Force Medical Center of China, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Bo NingDepartment of Intensive Care Unit, Air Force Medical Center of China, Beijing, 100142, People’s Republic of ChinaTel +86 15611161110Fax +86 1068410099Email boningbn@163.comQing SongMedical School of Chinese PLA, Beijing, 100853, People’s Republic of ChinaTel +86 13911374534Fax +86 1068182255Email songqing_sq87@163.comObjective: The purpose of this study is to evaluate the factors involved in the early stage of exertional heat stroke (EHS) that are associated with mortality.Methods: In this retrospective, case-control study, patients from 11 tertiary medical centers in China were enrolled from January 1, 2012, to December 31, 2019. Demographic information, underlying diseases, ambient temperature, and relative humidity, clinical manifestations, initial body temperature, time from onset to diagnosis of EHS (including suspected), and the duration of body temperature > 38°C of all enrolled patients were recorded. The occurrence of organ dysfunction within 72 h was evaluated, and in-hospital deaths were recorded. The patients were subsequently divided into a survival group and a non-survival group. The “case” refers to patients in the non-survival group, while the “control” refers to patients without death.Results: Of the 214 hospitalized patients with EHS, 183 survived and 31 died, and the overall mortality was 14.49% (31/214). A binary logistic regression showed that only the duration of body temperature > 38°C (OR 1.80, 95% CI 1.34– 2.42) and the number of organs damaged within 72 h of onset (OR 6.54, 95% CI 2.31– 18.56) were statistically significant in terms of risk of death in hospital (p < 0.05). A goodness of fit test produced a p-value of 0.76. According to receiver operating characteristic curve (ROC) analysis, the areas under the curve (AUC) were 0.989 (95% CI 0.978– 1.000; p < 0.05) and 0.936 (95% CI 0.896– 0.976; p < 0.05).Conclusion: Of the various factors involved in the early stage of the disease, the duration of high body temperature and the number of organs damaged within 72 h of onset were independent risk factors and predictors associated with death.Keywords: heat stroke, exertional, cooling, mortality

Abstract Heat stroke (HS) is a fatal disease caused by thermal damage in the body, and it has a very high mortality rate. In 2015, the People’s Liberation Army Professional Committee of Critical Care Medicine published the first expert consensus on HS in China, Expert consensus on standardized diagnosis and treatment for heat stroke. With an increased understanding of HS and new issues that emerged during the HS treatment in China in recent years, the 2015 consensus no longer meet the requirements for HS prevention and treatment. It is necessary to update the consensus to include the latest research evidence and establish a new consensus that has broader coverage, is more practical and is more in line with China’s national conditions. This new expert consensus includes new concept of HS, recommendations for laboratory tests and auxiliary examinations, new understanding of diagnosis and differential diagnosis, On-site emergency treatment and In-hospital treatment, translocation of HS patients and prevention of HS.

In this article, the authors review the most common presentations of cough and exertional headaches and headaches associated with sexual activity. The authors elaborate on the most commonly described etiologies and identify those which are most critical to treat. The authors outline the recommendations for further evaluation and discuss effective treatment modalities for each headache type., Competing Interests: Disclosure Dr M. Montenegro and Dr F.M. Cutrer have no financial conflicts of interest pertaining the content of the article., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Abstract Sickle cell trait has long been considered a benign condition but continues to be the leading cause of death in young African Americans in military basic training and civilian organized sports. There continues to be a great deal of controversy surrounding sickle cell trait and its association with exercise-related morbidity and sudden death. Even though sickle cell trait has a high prevalence among African Americans, many clinicians believe the potential adverse consequences should have been mitigated by actions such as universal screening in the USA at birth for sickle hemoglobin, National Collegiate Athletic Association (NCAA) rule changes, and changes in the US Military boot camp system. Sudden death due to periods of extreme physical exertion continues to occur in individuals with sickle cell trait.

This article reviews the disorders of thunderclap, cough, exertional and sexual headache. These are a group of paroxysmal and precipitated headaches, which often occur in bouts with prolonged remissions. Indometacin seems to be the most effective preventative. Each can occur in primary and secondary form. Thunderclap headache is the most frequently reported headache syndrome associated with a secondary pathology. Discussed are the complexities of whether all patients with thunderclap headache should have further investigation if timely computerised tomography is normal and, the relevance of abnormal imaging in these disorders, differentiating what is deemed to be secondary and managing the pain. [ABSTRACT FROM AUTHOR]

Background: Rhabdomyolysis is a potentially fatal condition that can be triggered by a variety of inciting events, including excessive muscular exertion. The purpose of this study was to investigate the causes of creatine kinase elevation (CK≥1000U/L) to determine what percentage result from exRML, the etiology, and kinetics of CK levels, as well as the complications of exRML and comorbidities that may predispose an individual to this condition. Methods: We performed a cross-sectional analysis of the emergency department database for patients with CK≥1000U/L between 2012 and 2017. In total, there were 1957 cases of rhabdomyolysis diagnosed based on laboratory data and documentation. Trauma was the most common cause for rhabdomyolysis (n = 726/1957; 37.1%, respectively). Results: ExRML was identified in 2.1% (n = 42/1957) of the total cases. Patients with ExRML were significantly younger (30.1 ± 10.6 years) with a significantly higher maximal level of CK compared to the non-exertional causes of rhabdomyolysis, (CK = 16,884.4 ± 41,645.6U/L; both p < 0.005). The far majority of cases were sport or exercise related (n = 35/42; 83.3%), with strength training at the gym making up the largest group of athletes (n = 16/42; 38.1%). The main complication amongst the ExRML group was acute kidney insufficiency, which was observed in 42.9% of patients. The CK levels of the patients in the ExRML cohort steadily decreased after initiation of aggressive hydration. Conclusion: ExRML may be more prevalent than the current literature predicts, which is important to recognize as it has the potential to cause kidney failure, irregular heart rhythm, and death. Therefore, physicians and active individuals should be sensitized to the signs and symptoms that may lead to earlier recognition and proper treatment in exercising individuals. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the rate of and risk factors for complications following non-traumatic compartment syndrome decompression. Methods: The National Surgical Quality Improvement Program database was queried from 2006 to 2016 for non-traumatic compartment syndrome diagnosis codes. Multivariate analysis was performed to identify risk factors for 30-day complications and hospital readmissions. Results: Overall complication, major complication, minor complication, and hospital readmission rates were 4.5%, 2.5%, 2.3%, and 2.0%, respectively. Active smoking was identified as a risk factor for post-operative complication (95%CI 1.19-9.24). Conclusion: The complication profile of non-traumatic compartment syndrome decompression is higher than that of traditional elective orthopaedic surgery. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Chronic exertional compartment syndrome (CECS) is an overuse injury characterized by increased intracompartmental pressure during exercise. CECS has been described in the foot, thigh, and trunk, but 95% of cases occur in the lower leg. Interestingly, CECS may also affect the upper extremities and has been best described in the forearms. Unfortunately, due to the rarity of this condition, there is no consensus regarding its diagnosis and treatment. This review seeks to discuss the prevalence, etiology, diagnosis, and treatment of CECS of the forearms, which has been described in the literature. [ABSTRACT FROM AUTHOR]

Utilizing metadata from existing exertional and exertional-heat stress studies, the study aimed to determine if the exercise-associated increase in core body temperature can predict the change in exercise-induced gastrointestinal syndrome (EIGS) biomarkers and exercise-associated gastrointestinal symptoms (Ex-GIS). Endurance-trained individuals completed 2 h of running exercise in temperate (21.2-30.0°C) to hot (35.0-37.2°C) ambient conditions (n = 132 trials). Blood samples were collected pre- and post-exercise to determine the change in gastrointestinal integrity biomarkers and systemic inflammatory cytokines. Physiological and thermoregulatory strain variables were assessed every 10-15 min during exercise. The strength of the linear relationship between maximal (M-Tre) and change (Δ Tre) in rectal temperature and EIGS variables was determined via Spearman's rank correlation coefficients. While the strength of prediction was determined via simple and multiple linear regression analyses dependent on screened EIGS and Ex-GIS confounding factors. Significant positive correlations between Tre maximum (M-Tre) and change (Δ Tre) with I-FABP (rs = 0.434, p < 0.001; and rs = 0.305, p < 0.001; respectively), sCD14 (rs = 0.358, p < 0.001; and rs = 0.362, p < 0.001), systemic inflammatory response profile (SIR-Profile) (p < 0.001), and total Ex-GIS (p < 0.05) were observed. M-Tre and Δ Tre significantly predicted (adjusted R2) magnitude of change in I-FABP (R2(2,123)=0.164, p < 0.001; and R2(2,119)=0.058, p = 0.011; respectively), sCD14 (R2(2,81)=0.249, p < 0.001; and R2(2,77)=0.214, p < 0.001), SIR-Profile (p < 0.001), and total Ex-GIS (p < 0.05). Strong to weak correlations were observed between M-Tre and Δ Tre with plasma concentrations of I-FABP, sCD14, SIR-Profile, and Ex-GIS in response to exercise. M-Tre and Δ Tre can predict the magnitude of these EIGS variables and Ex-GIS in response to exercise., Competing Interests: No potential conflict of interest was reported by the authors., (© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Background: Chronic exertional compartment syndrome (CECS) involves a painful increase in compartment pressure caused by exercise and relieved by rest, common in athletes. The most common site for CECS in the lower limbs is the anterior leg compartment. The aim of this study is to evaluate the outcomes of a single minimal incision fasciotomy in athletes and their capability to return to high level sport activity. Methods: The study reports mid-term results in a series of 18 consecutive athletes with chronic exertional compartment syndrome of the leg who had undergone minimally invasive fasciotomy. Between 2000 and 2007, we prospectively enrolled 18 consecutive athletes (12 males and six females, median age 27 years) with unilateral or bilateral chronic exertional compartment syndrome undergoing unilateral or bilateral minimally invasive fasciotomy. Clinical outcomes were assessed with Short-Form Health Survey-36 (SF-36) and European Quality of Life-5 Dimension (EQ-5D) scale. The ability to participate in sport before and after surgery and the time to return to training (RTT) and to sport (RTS) were recorded. Results: The median follow-up after surgery was 36 months. Both questionnaires showed a statistically significant improvement (P < 0.0001) after surgery. At the time of the latest follow-up, 17 of 18 patients (94 %) had returned to pre-injury or higher levels of sport. Only one patient (6 %) returned to sport at lower levels than those of pre-injury status. The median time to return to training and to return to sport was 8 and 13 weeks, respectively. No severe complications or recurrence of the symptoms were recorded. Conclusions: Minimally invasive fasciotomy is effective and safe for athletes suffering from unilateral or bilateral chronic exertional compartment syndrome of the anterior and lateral compartments of the leg with good results in the mid-term. [ABSTRACT FROM AUTHOR]

Paroxysmal dyskinesia represents a group of uncommon movement disorders that are characterized by episodes of abnormal movements arising from a baseline of normal or nearly normal movement. Recent advances in the genetics of these disorders have helped provide some unification of classification schemes and better understanding. However, the approach to treatment continues to be based on the phenotype more than the genotype. The treatment approach is primarily based on the factors that precipitate the episodes of abnormal movements. For paroxysmal kinesigenic dyskinesia (PKD) in which the spells are triggered by sudden movement, treatment with anticonvulsants that target voltage-sensitive sodium channels (e.g., carbamazepine or phenytoin) is highly effective. For paroxysmal nonkinesigenic dyskinesia (PNKD), treatment with benzodiazepines is effective in many patients. PNKD episodes are often precipitated by caffeine, ethanol, or sleep deprivation, and lifestyle modifications are often helpful. Paroxysmal exertion-induced dyskinesia (PED) is less likely to respond to medications, but the ketogenic diet or modified Atkins diet may provide benefit. As more knowledge is gained about the underlying biology of these disorders, additional treatments may emerge. [ABSTRACT FROM AUTHOR]

Introduction We present the case of a patient with exertional fat embolism on isolated exercise of his right leg two and four months after right total hip joint replacement. His immediate post-operative period had also been complicated by an acute episode of chest pain and hypotension, treated as acute coronary syndrome. To the best of our knowledge, this is the first reported case of exertional fat embolism following orthopedic surgery. Case presentation A 71-year-old Caucasian man underwent elective cementless total right hip joint replacement. His acute post-operative period was complicated by an episode of chest pain and hypotension. This was treated as acute coronary syndrome. Two months later, a routine stress echocardiography demonstrated a shower of small, echodense bubbles in his right heart, reproduced on exercise of his right leg but not his left. Computed tomography pulmonary angiography excluded pulmonary thromboemboli. A technetium-99m colloid scan confirmed pulmonary fat emboli. Similar findings occurred again four months after the operation but had resolved at six months. Conclusions Fat embolism is a well-described phenomenon in the acute setting after long-bone trauma or intramedullary manipulation, and the rare fat embolism syndrome can be fatal. Exertional fat embolism months after joint replacement, however, is an undescribed phenomenon that may have implications in the sub-acute post-operative phase. This may be of particular interest to those involved in orthopedics, cardiology and rehabilitation, but the large volume of patients undergoing joint replacements may broaden the clinical scope of this unusual presentation far beyond these specialties. [ABSTRACT FROM AUTHOR]

• The Dyspnoea Challenge is a novel measure of exertional dyspnoea which uses an important precipitator: walking uphill. • The Dyspnoea Challenge is repeatable and at low intensity produces similar exertional dyspnea as the six-minute walk test. • At high intensity, the Dyspnoea Challenge is a repeatable test that induces moderate-to-high levels of exertional dyspnoea. Exertional dyspnoea(ED) is a hallmark of chronic obstructive pulmonary disease(COPD). We examined the repeatability and face validity of the end-exercise ED(ED end) response during the Dyspnoea Challenge and compared those to the six-minute walk test (6MWT) in COPD. Twenty-six individuals with COPD(13 Females, age:69 ± 5.5yrs, FEV 1 :63.4 ± 11.9 %) completed 2 × 6MWTs and 4 x Dyspnoea Challenges on three occasions. The challenge consisted of a two-minute treadmill walk at 80 % of 6MWT speed(3.9 ± 0.5 km·hr−1) at either a low(LI DC :5.3 ± 2%) or high angle of incline(HI DC :9.5 ± 3%). Dyspnoea(0−10 scale), heart rate(HR) and oxygen saturation(S p O 2) were monitored continuously. Mean 6MWT distance was 488 ± 58 m. End-exercise ED and HR were higher in the HI DC (ED end 6.2 ± 2.0; HR: 123 ± 17beats·min−1) compared to the LI DC (ED end 4.2 ± 2.0; HR: 119 ± 15beats·min−1) and the 6MWT(ED end 4.3 ± 2.0; HR: 115 ± 16beats·min−1)(P < 0.01). SpO 2 was not different between 6MWT, LI DC or HI DC (P = 0.34). The intraclass correlation coefficient(ICC) for each intensity was excellent (HI DC , ICC = 0.88, LI DC , ICC = 0.93, P < 0.001) with neither reporting bias(HI DC , P = 0.63; LI DC , P = 0.94). The Dyspnoea Challenge is a simple measure of ED that appears to have both repeatability and face validity. With further optimisation, this test may enhance the field-based clinical assessment of ED. [ABSTRACT FROM AUTHOR]

Background: Chronic exertional compartment syndrome (CECS) is a condition that causes reversible ischemia and lower extremity pain during exercise. To date there are few large studies examining the characteristics of patients with CECS. This study aimed to present these characteristics by examining the largest published series of patients with a confirmed diagnosis of the disorder. Methods: An IRB-approved, retrospective review was undertaken of patients with a suspected diagnosis of CECS undergoing pre- and postexercise compartment pressure testing between 2000 and 2012. Patients were evaluated for gender, age, duration of symptoms, pain level, specific compartments involved, compartment pressure measurements, and participation and type of athletics. Results: Two-hundred twenty-six patients (393 legs) underwent compartment pressure testing. A diagnosis of CECS was made in 153 (67.7%) patients and 250 (63.6%) legs with elevated compartment measurements; average age of the patients was 24 years (range, 13-69 years). Female patients accounted for 92 (60.1%) of those with elevated pressures. Anterior and lateral compartment pressures were elevated most frequently, with 200 (42.5%) and 167 (35.5%) compartments, respectively. One hundred forty-one (92.2%) patients reported participation in sports, with running being the most common individual sport and soccer being the most common team sport. Duration of pain prior to diagnosis averaged 28 months. Conclusion: Although there is ample literature pertaining to the diagnostic criteria and treatment algorithm of the condition, few papers have described the type of patient most likely to develop CECS. This is the largest study to date to evaluate the type of patient likely to present with chronic exertional compartment syndrome. Level of Evidence: Level III, retrospective review. [ABSTRACT FROM AUTHOR]

Copyright of West Indian Medical Journal is the property of West Indian Medical Journal (WIMJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Compartment syndrome involves the sustained elevation of interstitial tissue pressures within an osteofascial envelope to nonphysiologic levels. Tissue injury involves a spectrum from reversible to irreversible damage and, therefore, early recognition and treatment is critical for optimal outcomes. This article reviews the nature of upper extremity compartment syndrome; considers the general classification scheme and potential causes; and discusses the pertinent anatomy, pathophysiology, treatment recommendations, and outcomes for this challenging condition. [ABSTRACT FROM AUTHOR]