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By D. Yokian. Wake Forest University.

The manifestation of the The disease was described by Maffucci in 1881 buy 50 mg imitrex otc. Both sexes inherited, because if all cells are affected by the genetic are equally affected. The hemangiomas are already present at birth and The following are distinguished: occur principally at subcutaneous level, enabling a diag- monostotic form ( Chapter 4. A recent investigation has polyostotic form, provided evidence to indicate the presence of numerous McCune-Albright syndrome (polyostotic fibrous dys- nerve fibers and the secretion of large quantities of mito- plasia, pigmentations of the skin, hormonal disorders genic neurotransmitters in the vicinity of the hemangio- with precocious puberty). These neurotransmitters play a role in the pathogen- esis of the disease. The enchondromas in Maffucci While the various forms of fibrous dysplasia are rare, the syndrome, and thus the orthopaedic problems as well, are monostotic type in particular often involves no clinical signs similar to those in Ollier disease, as is the risk of their ma- and symptoms. As a result, a relatively large number of cases lignant degeneration, for which a figure of 23% has been remain unreported. By contrast, the risk of degeneration of the in Great Britain has been calculated for the polyostotic form hemangiomas or hemangioendotheliomas is very low. Females are slightly more frequently affected (Polyostotic) fibrous dysplasia, Albright syndrome than males. The McCune-Albright syndrome is extremely rare (less than 5% of all cases of fibrous dysplasia). The congenital developmental disorder progresses slowly These lesions increase in size as the patient grows. The as the child grows and normally comes to a halt on condition can affect a single or multiple bones and, very completion of growth. The condition is usually diagnosed rarely, is associated with endocrine abnormalities such as during the first decade, although often not until the sec- precocious puberty, premature physeal closure and hy- ond decade. When associated with hormonal disorders but most commonly affect the proximal metaphysis of the condition is known as Albright syndrome.

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Olympic Committee (Fuentes discount 50 mg imitrex mastercard, Rosenberg, and TABLE 25-8 Summary of 26th Bethesda Conference Davis, 1996). Recommendations for Patients with Coronary Artery Disease Restriction of activity for athletes with hypertension depends on the degree of target organ damage and on General the overall control of the blood pressure (Maron and 1. All athletes should understand that the risk of a cardiac event with exertion is probably increased once coronary artery disease is present. Athletes should be informed of the nature of prodromal symptoms Fitness, 1997). Athletes with severe degrees of and low dynamic competitive sports (IA and IIA) and avoid hypertension should be restricted, particularly from intensely competitive situations. May participate in low intensity static sports, until their hypertension is controlled. These patients should be reevaluated every 6 diseases, eligibility for competitive sports is usually months and should undergo repeat exercise testing at least yearly. In children and adolescents, the presence of severe hypertension or target organ disease warrants restriction until hypertension is under adequate con- stratification prior to returning to their active lifestyle trol. The presence of significant hypertension should (Kugler, O’Connor, and Oriscello, 2001). They will not limit a young athlete’s eligibility for competitive require procedures for left ventricular assessment, athletics. This provides a general and conservative approach to Vigorous exercise represents a dangerous paradox for the individual in regards to competitive sports. While it may be The American College of Sports Medicine has recently a potent preventive tool, it can also represent substan- published guidelines that assist the primary care physi- tial risk for the susceptible individual.

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The benefit of this procedure is that niques (Glorioso and Wilckens order 50 mg imitrex fast delivery, 2001a). There are several negative aspects of this ing both static and dynamic intramuscular pres- technique. Techniques include the needle manometer ment of catheter in the compartment during activity, (Whitesides et al, 1975), the wick catheter (Mubarak attachment of the system to the athlete, and restric- et al, 1976), slit catheter (Rorabeck et al, 1981), con- tions of the athlete’s gait as they run to reproduce tinuous infusion (Matsen et al, 1976), and a solid-state symptoms. The procedure must be performed on a transducer intracompartmental catheter (McDermott treadmill in order to continuously monitor pressure et al, 1982). Thus, the athlete cannot run outdoors on The Stryker Intracompartmental Pressure Monitor their usual training surface. In addition, only one (Stryker Corporation, Kalamazoo, Michigan) is a bat- compartment can be measured at a time. Some tery operated, hand-held, digital, fluid pressure moni- believe that with this technique, the results are tor. This device has been found to be more accurate, inconsistent and difficult to obtain and interpret versatile, convenient, and much less time consuming (Rorabeck et al, 1988; Rorabeck, Fowler, and Nott, in the clinical setting (Hutchinson and Ireland, 1999; 1988). Prior to attempting to meas- Three factors may alter the pressure measurements: ure compartment pressures, the physician should 1. Proper calibration of the monitor is essential for ensure an understanding of the anatomical structures reliable readings. The monitor must be zeroed at in each compartment so as to avoid damage to neu- the same angle that will be used to penetrate the rovascular structures. Joint position at both the knee and ankle affect athlete counseled on the risk of infection, scarring, pressures (Gershuni et al, 1984). Externally applied pressure is additive to Two types of measurements may be obtained during any pressure already existing within the compart- the procedure, static or dynamic. Static, or intermittent, pressures are performed Each compartment should be approached with an with a straight needle. Here, intracompartmental understanding of the anatomical contents of each pressures are determined with a needle stick at rest compartment so as to avoid injury to neurovascular and then again after exertion. A negative aspect of structures, each compartment should be approached this technique is that it requires at least two needle with an understanding of the anatomical contents stick into each compartment being evaluated (one (Glorioso and Wilckens, 2001a).

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Lesions in limbs are especially easy to use local anaesthetic to reduce discomfort after to biopsy with US guidance as the needle may enter the procedure buy imitrex 25 mg with mastercard. The Guidance needle tip may be the only part seen as sound reflects off the obliquely placed needle shaft away from the Image guidance will depend on the location of the imaging area. It should permit visualization of the area or the tip of the needle as a bright oscillating object. Care should be take to keep the US plane pointing For example, if there is risk of puncturing bowel, CT is along the needle track or the tip may be lost. Most soft tissue of the needle is lost it is best to ignore the screen for masses will be best biopsied using US guidance. The needle is introduced at close to 90° to the ultrasound beam allowing visualiza- tion of the shaft Interventional Techniques 87 patient and the needle. MR has the potential attractions of being free from radiation and allowing the operator to stand next to the patient although an open system is far preferred 6. Needles can be seen on MR, Post-procedure although their conspicuousness depends on the align- ment with respect to the magnetic field. Interven- Risks of biopsy include, puncture of vessels and tional MR systems will be available where the track of viscus, infection, allergy to the drugs and haemor- the needle is predicted by a set of video cameras that rhage. The time of post-procedure observation will locate the needle in space by white makers placed on a depend on how likely these risks are and the nature needle holding extension. Clear written instruc- 1 second refreshing will then allow the needle to be tions should be given to the ward or day-case unit followed. The needle and all equipment will need to staff and analgesia should be prescribed.