Postoperative pulmonary edema in young, athletic adults

Pulmonary edema secondary to postextubation laryn gospasm is a potentially life-threatening problem, de manding early diagnosis and prompt treatment. We believe that this problem has been grossly underesti mated in its incidence, as only seven adults have been reported in the English literature, whereas seven adults have been observed at our institution in only a 24 month period. All were young, healthy, athletic adult males (average weight, 218 pounds) who underwent relatively minor, uncomplicated surgical procedures under gen eral anesthesia. Five of these patients were collegiate and/or profes sional athletes and had meticulous medical records detailing their clinical course. Clinical laryngospasm was noted immediately following extubation and anesthesia by mask with subsequent pulmonary edema. The di agnoses were confirmed by clinical examination, arterial blood gas determinations or pulse oximetry, and chest roentgenogram. Four adults required reintubation. Six of the seven adults demonstrated very rapid resolution of the pulmonary edema with prompt diagnosis and institution of a therapeutic regimen including oxygen, diuretics, reintubation, and/or positive pressure venti lation. In one patient, the problem was not immediately recognized, and progressed to florid pulmonary edema requiring emergent intubation 14 hours later in the emergency room, and 3 days of mechanical ventilation. The etiology of pulmonary edema following upper airway obstruction represents an interplay between several factors: cardiogenic and neurogenic mecha nisms, as well as hypoxia contribute. In this group, excessive negative intrathoracic pressure generated by forced inspiration against a closed glottis is the most likely, consistent, and logical explanation. This study suggests that young, healthy, athletic males may be at increased risk for this complication. We believe that their enhanced ability to generate ex cessive negative intrathoracic pressures is, at least in part, responsible. A heightened awareness of the prob lem in this at-risk group should invoke special consid erations, including choice of anesthesia, precautions on extubation, prolonged monitoring in the recovery phase if laryngospasm is observed or suspected, and rapid therapeutic intervention.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66519/2/10.1177_036354659101900407.pd

Goal Post Injuries in Soccer

Soccer is the most popular team sport worldwide, with approximately 40 million amateur participants. Most fa talities in soccer are related to player impact with the goal post. This study focuses on two case reports, a laboratory testing phase, and a pilot field testing phase of preventive equipment that can be used around the goal to prevent injury. Horizontal and vertical impact testing in the laboratory revealed impact force was di minished when the goal post was covered with protec tive padding (reduction of 31% and 63%) (P < 0.05). These data showed a statistically significant decrease in force at all temperatures. In the pilot field testing phase of the study, 471 games were monitored. Soccer teams participating in youth, teen, and adult soccer leagues were included in this phase of the study. During the 3-year study, there were seven player collisions with padded goal posts, and no injuries were recorded. The use of padded goal posts within the game of soccer has been documented to reduce the possibility of injury, both in the laboratory phase and in the pilot field testing phase.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66584/2/10.1177_036354659502300316.pd

A three-phase analysis of the prevention of recreational softball injuries

Recreational sports injuries are expensive to society. Prevention of such injuries must be a major public health goal. In a previous retrospective study, base sliding was found to be responsible for 71 % of recreational softball injuries. Because most injuries occurred during rapid deceleration against stationary bases, quick-release (break-away) bases were evaluated as a means to modify this mechanism of injury. In a prospective study, 633 softball games were played on break-away base fields and 627 games were played on stationary base fields. Forty-five sliding injuries occurred on the station ary base diamonds (1 injury for every 13.9 games) and only two sliding injuries occurred on the break-away fields (1 injury for every 316.5 games). The medical costs for injuries on the stationary base fields was 79 times greater than that on the break-away fields. In a 1035 game follow-up study performed on all fields equipped with break-away bases, two sliding injuries occurred (1 injury for every 517.5 games). Installing break-away bases in fields used by recrea tional leagues would achieve a significant reduction of serious softball injuries (98%) and, therefore, should be mandatory. Based on our findings, the Centers for Disease Con trol has estimated 1.7 million injuries would be pre vented nationally per year, saving $2.0 billion per year nationally in acute medical care costs.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67297/2/10.1177_036354659001800613.pd

Double-well magnetic trap for Bose-Einstein condensates

We present a magnetic trapping scheme for neutral atoms based on a hybrid of Ioffe-Pritchard and Time-averaged Orbiting Potential traps. The resulting double-well magnetic potential has readily controllable barrier height and well separation. This offers a new tool for studying the behavior of Bose condensates in double-well potentials, including atom interferometry and Josephson tunneling. We formulate a description for the potential of this magnetic trap and discuss practical issues such as loading with atoms, evaporative cooling and manipulating the potential.Comment: 7 pages, 6 figures, Revtex

Developmental Orthopaedics. II: The Spine, Trauma and Infection

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65928/1/j.1469-8749.1982.tb08806.x.pd