Lésions de surcharge chez l'enfant [Overuse injuries in children].

The physical-activity and sporting at the child and the teenager is probably, in these years 2000, in full change. In a paradoxical way, extremely sporting children or teenagers are living beside extremely sedentary school-boys, neglecting the majority of the physical-activities and preferring a home-lifestyle. In the evaluation of overload sporting lesion of at teenager, it is thus imperative to take into account not only the individual characteristics of the child: its sex, its age, its stage of growth, its psychology, the presence or not of preexistent pathologies or anatomical disorders. It is naturally necessary to wonder about the training methods of the activity, but it appears fundamental to me to evaluate the child from a sensitivo-motor point of view and this can be carried out by assessments physio-therapeutic or aptitude tests carried out by doctors of the sport.

Extensor carpi ulnaris (ECU) subsheath: Normal MRI appearance and findings in athletic injuries : 40

Purpose: First, to report ECU subsheath's normal MRI appearance and the findings in athletic injuries. Second, to determine the best MRI sequence for diagnosis. Methods and materials: Sixteen patients (13 males, 3 females, mean age 30.3 years) with ECU subsheath's athletic injuries sustained between January 2003 and June 2009 were retrospectively reviewed. Wrist MRI studies were performed on 1.5-T units and consisted of at least transverse T1 and STIR sequences in pronation, and FS Gd T1 in pronation and supination. Two radiologists assessed the following items, in consensus: injury type (A to C according to Inoue), ECU tendon stability, and associated lesions (ulnar head oedema, extensor retinaculum injury, ECU tendinosis and tenosynovitis). Then, each reader independently rated the sequences' diagnostic value: 0 = questionable, 1 = suggestive, 2 = certain. Follow-up studies were present in 8 patients. ECU subsheath's normal visibility (medial, central and lateral parts) was retrospectively evaluated in 30 consecutive control MRI studies. Results: FS Gd T1 sequences in supination (1.63) and pronation (1.59) were the most valuable for diagnosis, compared to STIR (1.22) and T1 (1). The study group included 9 type A, 1 type B and 6 type C injuries. There were trends towards diminution in pouches' size, signal intensity and enhancement in follow-up studies, along with tendon stabilization within the ulnar groove. In control studies, ECU subsheath's visibility in medial, central and lateral parts were noted in 66.7-80%, 63.3-80% and 30-50% respectively. Conclusion: ECU subsheath's athletic injuries are visible on 1.5-T MRI studies. FS Gd T1 sequences in supination and pronation are the most valuable.

A novel cyclosporin a aqueous formulation for dry eye treatment: in vitro and in vivo evaluation.

PURPOSE: The aim of the present study was the in vitro and in vivo evaluation of a novel aqueous formulation based on polymeric micelles for the topical delivery of cyclosporine A for dry eye treatment. METHODS: In vitro experiments were carried out on primary rabbit corneal cells, which were characterized by immunocytochemistry using fluorescein-labeled lectin I/isolectin B4 for the endothelial cells and mouse monoclonal antibody to cytokeratin 3+12 for the epithelial ones. Living cells were incubated for 1 hour or 24 hours with a fluorescently labeled micelle formulation and analyzed by fluorescence microscopy. In vivo evaluations were done by Schirmer test, osmolarity measurement, CyA kinetics in tears, and CyA ocular distribution after topical instillation. A 0.05% CyA micelle formulation was compared to a marketed emulsion (Restasis). RESULTS: The in vitro experiments showed the internalization of micelles in the living cells. The Schirmer test and osmolarity measurements demonstrated that micelles did not alter the ocular surface properties. The evaluation of the tear fluid gave similar CyA kinetics values: AUC = 2339 ± 1032 min*μg/mL and 2321 ± 881.63; Cmax = 478 ± 111 μg/mL and 451 ± 74; half-life = 36 ± 9 min and 28 ± 9 for the micelle formulation and Restasis, respectively. The ocular distribution investigation revealed that the novel formulation delivered 1540 ± 400 ng CyA/g tissue to the cornea. CONCLUSIONS: The micelle formulation delivered active CyA into the cornea without evident negative influence on the ocular surface properties. This formulation could be applied for immune-related ocular surface diseases.

Unplanned complex suicide by self-strangulation associated with multiple sharp force injuries: a case report.

In cases of ligature strangulation, the importance of distinguishing self-inflicted death from homicide is crucial. This entails objective scene investigation, autopsy and anamnesis in order to elucidate the manner of death correctly. The authors report a case of unplanned complex suicide by means of self-strangulation and multiple sharp force injury. The use of more than one suicide method, consecutively--termed unplanned complex suicide--gives this case particular significance. A brief discussion on this uncommon method of suicide is presented, particularly relevant to the attending forensic physician. In addition, a short overview of the entity of complex suicide is given.

A comparison of injuries among children and adult football (soccer) players

Football is a universal and an affordable game but we need to minimize the incidence of accidents among the increasing number of young football players. Our 11 year retrospective epidemiological study (1990-2000) of football injuries in children (N= 1000) was compared with those of adult players in the 2006 European Championship. This comparative study confirmed that the anatomical, biomechanical and biological conditions differ between adults and children and that they warrant particular attention to protect the latter vulnerable group against bone avulsions, overuse pathologies and fatigue-fractures. Injuries were shown to increase significantly with age up to 16 years (P=0.005). Children suffer mainly from contusions, fractures and sprain injuries. Head injuries were more common in boys (P=0.070), while girls were more prone to sprains. The types of injuries differ between adults and children (sprain versus fractures), the anatomical location of injuries is different (lower limbs in adults, lower and upper limbs in children), the circumstances of the injuries are different (contact in adults versus non-contact in children), and teenage girls have different types of injuries than teenage boys. An increased incidence of injuries is due to changes in the position of the center of gravity and in the morphotype during rapid growth. For these reasons it is mandatory to adapt the training to the age and sex of the players. It is unsafe to train children the same way as adults. The height, the weight and the speed of growth must be taken into account by the multidisciplinary team when organising the training programmes. -- Le football fait partie des sports les plus pratiqués au monde en raison de sa popularité et de son accessibilité économ ique. L'incidence des blessures liées à cette pratique doit être diminuée surtout chez les jeunes joueurs en raison de la croissance exponentielle du nombre de joueurs féminins et masculins. Une étude épidémiologique rétrospective sur 11 ans (1990-2000) a été réalisée chez les enfants victimes de blessures liées au football (N==1000), puis a été comparée aux données recueillies de l'UEFA lors d'un Championnat Européen en 2006 sur les lésions des joueurs adultes. Cette étude comparative confirme que les structures anatomiques, biologiques et les tensions biomécaniques chez l'enfant diffèrent de celles de l'adulte. Les enfants ont un risque plus élevé de souffrir d'avulsion osseuse et de fractures de fatigue que les adultes. Les blessures augmentent significativement avec l'âge jusqu'à 16 ans (P==0,005). Les traumatismes crâniens sont plus fréquents chez les garçons tandis que les entorses sont plus à risque chez les filles. Les adultes font plus souvent des entorses tandis que les enfants font plus de fractures. La localisation anatomique diffère également entre ces deux groupes (les membres inférieurs chez l'adulte et les membres inférieurs et supérieurs chez l'enfant). La circonstance des blessures diffère également (choc avec un autre joueur chez l'adulte et des blessures sans contact chez l'enfant). Chez les adolescents, les blessures des filles diffèrent de celles des garçons. L'augmentation chez les enfants de cette incidence est liée au déplacement lors de la croissance du centre de gravité, avec une maladresse accrue lors des phases de croissance. Pour toutes ces raisons, il est justifié d'adapter les entraînements de football en fonction de l'âge, du sexe et du morphotype. L'entrainement des enfants doit être différent de celui des adultes. Le poids, la taille et la vitesse de croissance doit être prise en compte dans des structures multidisciplinaires afin de permettre une meilleure longévité sportive des jeunes joueurs de football.