The Addition of Sprint Interval Training to Field Lacrosse Training Increases Rate of Torque Development and Contractile Impulse in Female High School Field Lacrosse Players

Field lacrosse requires sudden directional changes and rapid acceleration/deceleration. The capacity to perform these skills is dependent on explosive muscle force production. Limited research exists on the potential of sprint interval training (SIT) to impact explosive muscle force production in field lacrosse players. The purpose of this study is to examine SIT, concurrent to field-lacrosse-specific training, on the rate of torque development (RTD), contractile impulse, and muscle function in female high school field lacrosse players (n = 12; 16 ± 1 yrs.). SIT was performed three times per week, concurrent to field-lacrosse-specific training, for 12 weeks. Right lower-limb muscle performance was assessed pre-, mid-, and post-SIT training via isometric and isokinetic concentric knee extensor contractions. Outcomes included RTD (Nm·s^-1), contractile impulse (Nm·s), and peak torque (Nm). RTD for the first 50 ms of contraction improved by 42% by midseason and remained elevated at postseason (p = 0.004, effect size (ES) = -577.3 to 66.5). Contractile impulse demonstrated a training effect across 0-50 ms (42%, p = 0.004, ES = -1.4 to 0.4), 0-100 ms (33%, p = 0.018, ES = 3.1 to 0.9), and 0-200 ms (22%, p = 0.031, ES = -7.8 to 1.6). Isometric (0 rad·s^-1) and concentric (3.1 rad·s^-1) strength increased by 20% (p = 0.002, ES = -60.8 to -20.8) and 9% (p = 0.038, ES = -18.2 to 0.0) from SIT and field-lacrosse-specific training, respectively (p < 0.05). SIT, concurrent to field-lacrosse-specific training, enhanced lower-limb skeletal muscle performance, which may enable greater sport-specific gains.

The use of physically constraining tools for grip-specific skill development in racket, stick and club sports: A scoping review

Coaches use physically constraining tools to supplement their coaching when developing sport-specific skills, however, their effectiveness is unknown. This scoping review aimed to understand the efficacy of physically constraining tools used in racket, stick, and club sports for grip-specific skill development. This scoping review followed the Joanna Briggs Institute methodology and PRISMA guidelines. Peer-reviewed research, including quasi-experimental, true-experimental, case studies, and grey literature were considered. Peer-reviewed sources were searched on Web of Science, Medline, and SPORTDiscus until October 6th, 2022. Exclusion criteria were (1) not original peer-reviewed research; (2) disabled participants or used for rehabilitation; or (3) not available in English. Data extracted were the type of tool, research foci, measures, and outcomes of the tool's efficacy. Zero peer-reviewed sources were identified on the efficacy of using physically constraining tools for grip-specific skill development. Common trends identified from the excluded sources were explored to provide a basis for the importance of using physically constraining tools for grip-specific skill development. Many tools are used in coaching despite their unclear efficacy, however, the current results can guide future work to assess the acute and longitudinal effects of using these tools, specifically within the development and performance of sport-specific skills.

Grip position affects upper limb kinematic chain during tennis double-handed backhand topspin strokes: considerations for transitioning tennis grip position technique

The purpose of this study was to compare the upper limb kinematic chain of tennis players using either an eastern or continental non-dominant grip position during the forward swing of the double-handed backhand stroke. Sixteen right-handed tennis players performed backhands using two non-dominant grip positions (eastern and continental), aiming for two cross-court zones (deep and short). Trajectory data were captured using sixty reflective markers attached to the upper limb and racket using a 12-camera Vicon motion capture system (250 Hz). Peak angular velocity was significantly greater for multiple joint rotations at the dominant shoulder and entire non-dominant limb in the eastern grip. Subsequently, greater peak racket head angular velocity and post-impact ball speed were generated by the eastern grip, while shot accuracy was similar between grip types. There was delayed dominant shoulder peak adduction angular velocity for the continental grip, possibly due to a lack of skill familiarity causing changes in coordinative patterns. Collectively, the non-dominant grip position appears to influence proximal and distal upper limb movement. Future research should explore upper limb segment coordination comparing preferred and non-preferred double-handed backhand techniques and complete inter-disciplinary investigations to understand what grip positions are most effective for individuals to learn double-handed backhands.

She'll Be ‘Right… but Are They? An Australian Perspective on Women in High Performance Sport Coaching

Participation and media coverage of women in high-performance sport has been steadily increasing in recent years throughout the world. While this increase in interest has led to many young women and girls becoming involved in grassroots sport, there has yet to be a significant change in the number of women in coaching roles, particularly at the high-performance level. This paper synthesizes and summarizes the current challenges facing women sport coaches in Australia, drawing from existing research, media and government reports to understand the barriers for women entering and progressing in these roles. We also present some of the more recent initiatives to increase opportunities for women in high performance coaching. Within Australia, there is a need to (1) understand the pipeline for women coaches, (2) examine the interacting contexts and constraints that women are subject to within sporting organizations, and (3) create a preliminary framework for future research, outreach, and education to address gender inequity within Australian sport coaching.

Effect of Sport-Specific Constraints on Aerobic Capacity in High School Field Hockey Players

ABSTRACT

Roberts, AH, Walden, AJ, Carter, KA, and Symons, TB. Effect of sport-specific constraints on aerobic capacity in high school field hockey players. J Strength Cond Res 36(2): 493-497, 2022-Many sports require the use of a mouth guard (MG) and carrying an object during play. Research has shown that individually these conditions can cause performance decrements; however, no research has been conducted into the effect of combining both mouth guard and stick with adolescent female field hockey players. This study aimed to determine the effects of MG and stick (STK) use on estimated aerobic capacity over the course of a season long training and competition period. Thirty-eight female high school field hockey players were separated into 2 groups: experimental (EXP-all training with MG-STK) or control (CTL-all training without MG-STK). Aerobic capacity was estimated using a multi-stage fitness test. Field hockey specific training prescribed by coaching staff was performed throughout the study, with testing at pre-, mid- and post-season. Subjects performed 2 sets of testing at each time point, first without MG-STK (WOMG-STK) and then with MG-STK. No main effect was observed in aerobic capacity estimations between groups; however, MG-STK testing reduced estimated aerobic capacity at each time point, regardless of the group (WOMG-STK: 37.4 ± 6. mL·kg-1·min-1 vs. MG-STK: 33.2 ± 4. mL·kg-1·min-1; p < 0.01). Chronic use of MG-STK does not seem to negatively impact estimates of aerobic capacity over the course of a season in high school field hockey players. Therefore, players should be encouraged to use MGs during all training sessions as it increases safety and familiarity with no decrement in long-term physiological performance.

Pilot Study on the Reliability of the Coach's Eye: Identifying Talent Throughout a 4-Day Cadet Judo Camp

A typical assumption found in talent identification literature is that different coaches, given the same athletes and circumstances, will identify the same subset of athletes as “talented”. However, while coaches play a major role during talent identification in practical sport settings, there is limited empirical research exploring the processes which underpin this. The purpose of this study was to explore the reliability of “the coach's eye” during the assessment of talent in a group of athletes. Specifically, this project compared inter-coach agreement between nine judo coaches (ages 35.8 ± 10.6 years) with varying levels of experience (12.9 ± 8.9 years) in the evaluation of 24 talented cadet judo athletes (13–15 years) at seven timepoints throughout a 4-day development training camp. Without discussion of their scores with other coaches, coaches provided a single score representing each athlete's “potential for future performance” on an 11-point Likert scale at each timepoint. Scores from each coach were converted into rankings from 1 to 24 to create a normalized scale to facilitate comparison of athletes. Based on their rankings at each timepoint, athletes were placed into one of three evenly distributed groups (high, medium, and low rank). Inter-coach agreement at each timepoint was determined by the number of coaches who ranked each athlete in the same group, categorized at three levels: 50, 75 or 100% agreement. Overall results showed that at completion of the camp, coaches reached 100% agreement on only two athletes, both of whom were in the high rank group. When inter-coach agreement was set at 50%, 15 athletes (62.5%) were placed into like groups. The first timepoint at which coaches were able to differentiate between the majority of athletes was Timepoint 3 (end of day 2). The findings suggest that, in isolation, coaches do not agree on the talent or potential of athletes. This indicates that the “coach's eye” is subjective and variable, and, given the same context, there is poor inter-coach agreement in the identification of talented athletes. In turn, these findings may have significant implications for both future talent identification research and athlete selection processes by sport organizations.

Understanding the "gut instinct" of expert coaches during talent identification

Coaches are an integral part of talent identification in sport and are often used as the "gold standard" against which scientific methods of talent identification are compared. However, their decision-making during this process is not well understood. In this article, we use an ecological approach to explore talent identification in combat sports. We interviewed twenty-four expert, international-level coaches from the Olympic disciplines of boxing, judo, and taekwondo (age: 48.7 + 7.5 years; experience: 20.8 + 8.3 years). Findings indicated that when coaches identify talent they rely on "gut instinct": intuitive judgements made without conscious thought, used to direct attention to particular athletes or characteristics. Our analysis revealed four major contributors to coaches' intuition: experiential knowledge, temporal factors, seeing athletes in context, and what can be worked with. Our findings demonstrate that i) athlete selections may be influenced by the coaches' perceived ability to improve certain athletes (rather than solely on athlete ability); and ii) "instinctual" decisions are the result of years of experience, time spent with the athlete, and the context surrounding the decision. Based on these findings, we recommend that future research focuses on the duration and conditions that are required for coaches to confidently and reliably identify talented athletes.

Coach knowledge in talent identification: A systematic review and meta-synthesis

OBJECTIVES

Talent identification traditionally relies on the knowledge and perceptions of expert coaches to identify and predict potential future elite athletes. Experiential coach knowledge is a valuable source of information to guide research in this ill-defined and under-researched area. This review aims to synthesize current empirical understanding of coach knowledge as it relates to decision making in talent identification.

DESIGN

This systematic review and meta-synthesis used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify relevant literature.

METHODS

Eligible studies were critically appraised for quality, and key findings from the 14 studies were integrated to allow for thematic analysis.

RESULTS

The meta-synthesis revealed the key theme of 'instinct' as the primary contributor to coach decisions during talent identification. Subordinate themes informing coach instinct were 'drive and ambition', 'game intelligence' and 'physical and technical skills'.

CONCLUSIONS

Coaches appear to make decisions about talent based on their tacit knowledge or instinct. Understanding how coaches develop these instinctual 'feelings' may guide future research into talent identification and enhance our understanding of how experiential coach knowledge is developed and utilised in the daily training environment.

The Effect of Protandim® Supplementation on Athletic Performance and Oxidative Blood Markers in Runners

The purpose of this study determined if oral supplementation of Protandim® (a nutraceutical) for 90 days improved 5-km running performance and reduced serum thiobarbituric acid-reacting substances (TBARS) at rest, an indicator of oxidative stress. Secondary objectives were to measure whole blood superoxide dismutase (SOD), glutathione (GSH), and glutathione peroxidase (GPX), at rest and 10 minutes after completion of the race before and after supplementation as well as quality of life. In a double-blind, randomized, placebo controlled trial, 38 runners [mean (SD) = 34 (7) yrs; BMI = 22 (2) kg/m2] received either 90 days of Protandim® [1 pill a day, n = 19)] or placebo (n = 19). Randomization was done in blocks of two controlling for sex and 5-km baseline performance. A 5-km race was performed at baseline and after 90 days of supplementation, with blood samples taken before and 10-min after each race. Fasting blood samples were acquired at baseline, after 30, 60, and 90 days of supplementation. TBARS, SOD, GPX, and GSH were assayed in an out-of-state accredited lab. Running performance was not altered by Protandim® or placebo [20.3 (2.1) minutes, with an -8 (33) seconds change in 5-km time regardless of group]. There was no change in TBARS, SOD, or GPX (at rest) after three months of Protandim® supplementation compared to placebo. However, in a subgroup ≥ 35 years of age, there was a 2-fold higher increase in SOD in those taking Protandim® for three months compared to those on placebo (p = 0.038). The mean post-race change in TBARS (compared to pre-race) increased by about 20% in half of the subjects, but was not altered between groups, even after three months of supplementation. Quality of life was also not different between the two conditions. In conclusion, Protandim® did not (1) alter 5-km running time, (2) lower TBARS at rest (3) raise antioxidant enzyme concentrations compared to placebo (with exception of SOD in those ≥ 35 years old) or, (4) affect quality of life compared to placebo.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02172625.

The influence of body mass index on burn surface area estimated from the area of the hand

It is well recognised that initial estimates of the area involved in a burn injury by inexperienced clinicians are frequently excessive. In Britain the palmar surface area of the hand is taught to approximate 1% of the total body surface area (TBSA), but no allowance is made for variations in individual body weight. This study aimed to evaluate the relationship between hand surface area (HSA) and body mass index (BMI) using healthy volunteers. We found that mean HSA diminished significantly as BMI increased in both sexes (P<0.001). This effect was, however, more pronounced in women, particularly those with a BMI greater than 31 kg/m(2) in whom the HSA represented only 0.64%. Awareness of the potential for over-estimation of burn surface area using this method alone may improve the accuracy of burn area estimation and consequent need for commencing resuscitation.

Dermal cellular inflammation in burns. an insight into the function of dermal microvascular anatomy

The damage caused by thermal trauma is augmented by the subsequent inflammatory response in a similar fashion to reperfusion injury. Animal studies have demonstrated a significant role for neutrophils in this delayed damage, but little is known about the numbers of neutrophils or other leucocytes that enter human skin following burns. We have longitudinally examined profiles of leucocyte migration into five cases of human partial thickness burns in relation to continued dermal microvascular destruction during the acute post-burn period. All burn wounds had a rapid influx of neutrophils that was followed by a delayed influx of macrophages. Compared to the controls, the two superficial burns also had rapid and sustained influx of CD4 and CD8 lymphocytes via patent post capillary venules in the dermal superficial vascular plexus, whilst in the three deeper burns, in which this superficial vascular plexus was occluded, the number of lymphocytes decreased. These results suggest that the patterns of leucocyte extravasation were dependent on the initial level of vascular occlusion, indicating that the dermal microvascular anatomy plays a pivotal role in determining the composition of the extravascular inflammatory cell infiltrates. The potential importance of this finding is highlighted by the differences in wound behaviour associated with the different leucocyte profiles.

Burn depth and its histological measurement

This paper describes a new technique for burn depth measurement, based on the histological assessment of dermal microvascular occlusion in burn biopsies. The technique was validated in a preliminary study of acute progressive microvascular damage in five adults with partial thickness burns. Burn depth was calculated at three time points post burn from the mean histological measurement of the most superficial patent and the deepest blocked vessels in five separate sections from each biopsy. The results were expressed as a percentage of the total dermal thickness and correlated well with the laser Doppler measurement of dermal blood flow and clinical estimation of burn depth. The reproducibility of the technique was tested by the repeated blind analysis of five randomly chosen biopsies on a separate occasion. Altman-Bland plot analysis demonstrated a median variation of 0.1% (95% confidence interval -1 to 2%). A second independent observer (MPHT), who carried out a blind analysis of the same randomly chosen biopsies, tested the precision of the technique. The median variation was 2% (95% confidence interval -5 to 8.5%).

Fluoride accumulation in pasture forages and soils following long-term applications of phosphorus fertilisers

Ingestion of soils with high fluoride (F) concentration may cause chronic fluorosis in grazing animals. Analysis of New Zealand pasture soils with long-term phosphorus (P) fertilisation histories showed that total surface soil (0-75 mm depth) F concentration increased up to 217-454 mg kg-1 with P fertiliser application. One-third to two-thirds of F applied in fertilisers resides in the top 75 mm soil depth. Pasture forage accumulation of F was low, and therefore, F intake by grazing animals through pasture consumption is expected to be much lower than F intake by soil ingestion. Ten annual applications of single superphosphate (30 and 60 kg P ha-1 year-1) to a Pallic Soil (Aeric Fragiaqualf) significantly increased total F and labile F (0.01 M CaCl2 extract) concentrations to 200 and 120 mm depths, respectively, of the 300 mm depth investigated. The mobility of F in the soil profile was similar to two other elements, P and cadmium derived from the fertiliser.

Burns sustained by hot bath and shower water

An 8-year retrospective review of patients admitted to Stoke Mandeville Hospital (Aylesbury, UK) because of burns sustained by hot bath and shower water was undertaken. Fifty-seven patients of all ages were identified and stratified into paediatric (< 16 years) and adult groups. Nine patients died. The main characteristics of the burns, causes and outcomes of treatment were analysed for each group. Children were predominantly under three years of age (83%), sustaining most frequently only superficial burns (41%) with areas of less than 10% total body surface area (72%). Parents' supervision was inadequate in 85% of cases. Eighty-three percent of the adults were over the age of 60. Two thirds had some form of psycho-motor disorder that predisposed to an accident which should have been anticipated. In comparison to children, adults suffered more extensive and deeper burns that resulted in a mortality of 44% (8/18). In both groups, the lower parts of the body were most frequently involved. The observed decline in the number of admissions for the period of investigation is encouraging. It supports an ultimate need for further development and actual implementation of preventative measures for hot water burns in the homes of people who are at greatest risk.

Frostbite: pathogenesis and treatment

Frostbite, once almost exclusively a military problem, is becoming more prevalent among the general population and should now be considered to be within the scope of the civilian physician's practice. Studies into the epidemiology of civilian frostbite have identified several risk factors that may aid the clinician in the diagnosis and management of cold injuries. Research into the pathophysiology has revealed marked similarities in inflammatory processes to those seen in thermal burns and ischemia/reperfusion injury. Evidence of the role of thromboxanes and prostaglandins has resulted in more active approaches to the medical treatment of frostbite wounds. Although the surgical management of frostbite involves delayed debridement 1 to 3 months after demarcation, recent improvements in radiologic assessment of tissue viability have led to the possibility of earlier surgical intervention. In addition, several adjunctive therapies, including vasodilators, thrombolysis, hyperbaric oxygen, and sympathectomy, are discussed.

Spontaneous rupture of extensor pollicis longus tendon in a kick boxer

A 23 year old male kick boxer presented with a 24 hour history of pain and being unable to extend the interphalangeal joint of the left thumb. There was no history of trauma or any other risk factor for spontaneous rupture of the extensor pollicis longus tendon. On the previous day, he had been doing reverse press ups on the dorsum of his hands with his wrists hyperflexed as part of his training for kick boxing. At operation the extensor pollicis longus tendon was found to be divided at the level of the dorsal tubercle of the radius and was not directly repairable. The treatment was an extensor indicis proprius transfer. We suggest that the cause of the tendon rupture was direct pressure on the dorsal tubercle of the radius sustained while performing reverse press ups.

Pleomorphic lipoma of the parotid gland

Lipomata are rare tumours of the parotid gland. The pleomorphic lipoma represents an unusual histological variant of the benign lipoma. We report a case of a pleomorphic lipoma arising in the parotid gland. Only one case of a similar nature has previously been recorded. This tumour is benign, was fully excised and recurrence is not expected.

The palmaris longus tendon. Another variation in its anatomy

The palmaris longus is one of the most variable muscles of the human body. An understanding of its variations is useful as it is often used as a tendon graft and for tendon transfer. We report another interesting variation in its anatomy.

The treatment of hand injuries

A major hand injury can completely change a person's life. The consequences of the injury can be reduced by proper assessment, appropriate treatment and careful follow-up. Whenever experienced help is available then it should always be sought. This article describes the management of hand injuries. In Papua New Guinea the worst disasters occur when injuries are missed on initial assessment and the patient is not referred to a surgeon. Another common cause of poor outcome is failure to splint the hand in the correct position.

Motor vehicle-related burns: a review of 107 cases

Motor vehicles are a major cause of morbidity and mortality. Burn injuries sustained from motor vehicles form a small but important subgroup. The authors have reviewed the case notes of 107 patients with motor vehicle-related burns over a 13-year period. The age ranged from 18 months to 65 years and the male to female ratio was 4:1. The mechanisms of injury were variable, although four major categories could be identified. These accounted for 83 per cent of the cases. Car fires following road traffic accidents was the largest group accounting for 48.5 per cent of cases. The remaining three groups were: motorcycle-related burns following road traffic accidents (6.5 per cent of cases), garage fire-related burns (15 per cent of cases) and car radiator-related burns (13 per cent of cases). Garage fire-related burns had the highest mortality of the four groups (25 per cent). This study demonstrated that garage fire burns are an important subgroup of motor vehicle-related burns.

Volitional vasomotor lability and vasomotor control

This experiment tested the hypothesis that skin temperature variability during instructions to attempt skin temperature self-control without feedback (volitional vasomotor lability) predicts the acquisition of vasomotor control through biofeedback training. Skin temperature was recorded from the hands of 232 volunteers during a screening session. Twenty-three labile and 17 stabile subjects were chosen to participate in a 16-session training program under double blind conditions. Visual and auditory feedback were used to train subjects to produce temperature differences between the two hands in a specified direction. Comparisons between the labile and stabile groups revealed statistically significant differences in the predicted direction on measures of performance and learning. These findings provide preliminary support for the hypothesized positive relationship between volitional temperature variability and voluntary vasomotor control. Fruitful directions for future research are suggested.

Domestic iron burns in children: a cause for concern?

The case notes of 26 children with contact thermal burns to the hand who were treated in the Burn Unit at Stroke Mandeville Hospital as inpatients during the period 1987-92 have been reviewed. The burns were found to be caused by a variety of injuring agents, although the domestic iron was the single commonest cause accounting for 46 per cent of cases. Mechanisms of iron injuries were variable although leaving a hot iron on the floor or on a low table were identified as being two important causes. Fifteen children (58 per cent) underwent either primary or tangential excision of the burn skin and grafting. The majority of the children had a satisfactory outcome, although five children (19 per cent) developed hypertrophic scars. The results of this study demonstrate the relatively high incidence of domestic iron burns as a causative factor for contact hand burns in children. Parental vigilance and leaving a hot iron in a secure place are two factors which will help to reduce the incidence of this potentially serious injury.

Pretibial injuries in the elderly: a prospective trial of early mobilisation versus bed rest following surgical treatment

Pretibial lacerations are a common form of injury of the elderly population. With respect to graft healing, controversy exists regarding rehabilitation by early ambulation, following debridement and split skin grafting. In a prospective, randomised trial comparing early mobilisation (n = 21) with the traditional method of a period of in-patient bed rest after surgical treatment (n = 40), no statistically significant difference has been found in the percentage area of skin graft take at either 1 or 3 weeks postoperatively. The method of anaesthesia (local or general) has no significant effect on the outcome of healing. Prolonged bed rest has a detrimental effect on return to independent mobility in one third of cases. Complications related to the wound site are similar in both groups. Hospital stay averaged 12 days in those confined to bed, compared to an average of 2 days in those who were allowed to walk immediately.

Burn injuries in boating accidents

We report a series of burn injuries sustained on boats and admitted to Stoke Mandeville Hospital over a 4-year period. Nine patients are presented, aged between 27 and 65 years. Total body surface area burned ranged from 1.5 to 83 per cent. The causes of the injuries, and the factors leading to the accidents which caused them, are discussed. Interviews with a number of private boat owners and hirers revealed an inadequate level of fire and safety precautions taken. There is at present no legal requirement for private boats to carry five fighting equipment. We believe there is a need for definition of the minimum legal level of such equipment to be carried on board. Increased awareness of correct fuel storage and handling requirements is felt to be important, especially with the increasing popularity of boating as a leisure and sporting activity.

The estimation of blood loss during burns surgery

The estimations of blood loss and transfusion requirements during burns surgery are notoriously difficult. This clinical study investigated the effectiveness of estimates made by junior and senior burns surgeons and senior anaesthetists by comparing them with calculated blood losses. Regression analysis shows good correlation between these methods (r-value range 0.75-0.97), although 'eye-balling' the losses tends to underestimate the transfusion requirements (regression slope coefficients ranged between 0.56 and 0.87). In only five out of 46 procedures was there a need for late transfusion for an unacceptably low haemoglobin level (< 10 g/dl). This provides further empirical evidence for the clinical value of each member of the team voicing an estimate of the loss at the end of the procedure. The mean blood loss for 1 per cent of burn excised or split skin donor site harvested was 117 ml in adult cases. Blood loss can also be expressed as a mean percentage of the patient's calculated total blood volume for each 1 per cent burn excised or autograft harvested, giving figures of 2.6 per cent for adults and 3.4 per cent for children. Gravimetric analysis of soiled swabs underestimates the blood loss by approximately 50 per cent.

Behavioral management of chronic pain and excess disability: long-term follow-up of an outpatient program

OBJECTIVE

To assess the overall efficiency of an outpatient behavioral rehabilitation program for excess disability and chronic pain and to describe the program staff, treatment components and outcomes in sufficient detail to facilitate comparison with similar programs.

DESIGN

Eight-year follow-up study of patients referred and treated.

SETTING

Outpatient primary care and multispecialty group medical practice.

PATIENTS

354 of 421 unselected patients referred for the behavioral management of excess disability, who completed the treatment program and participated in follow-up.

INTERVENTIONS

15-20 sessions of physical and occupational therapy, 5-10 sessions of biofeedback, and one or two family sessions all based upon behavioral techniques described by Fordyce and by Roberts.

MAIN OUTCOME MEASURES

Questionnaires, including analog scales, administered before treatment and at 1, 6, 12, and 24 months posttreatment.

RESULTS

Patients (n = 67) who dropped out did not differ systematically from those who participated (n = 354). The treatment program resulted in a marked and enduring reduction of pain, and a statistically and clinically significant improvement in patients' ability to function at work and in the home. Patients overwhelmingly endorsed the program.

CONCLUSIONS

A brief, inexpensive, outpatient behavioral rehabilitation program for chronic pain and excess disability can achieve a clinically significant and lasting reduction of pain and improvement in function at work and at home.

Burns following cigarette lighter fluid abuse

Seven patients with burns associated with butane cigarette lighter fluid abuse, in a group setting within an enclosed space, are presented. In all patients there was a reluctance to admit that butane vapour was in use as an intoxicant immediately prior to the injury. It is obvious from the circumstances of these injuries that the hazardous nature of cigarette lighter fluid is not fully appreciated. Since the resultant injuries are usually minor (all patients recovered spontaneously with conservative management, the hospital stay averaging 2 days), it is probable that many more occur, but do not present to accident departments as the victims are wary of repercussions should they admit to intoxicant vapour abuse. In view of the medical sequelae that can follow butane inhalation, burns unit staff should be aware of the problems, their recognition and treatment.

Localized nodular synovitis: a rare cause of ulnar nerve compression in Guyon's canal

A rare case of ulnar nerve entrapment at the wrist by a nodule of localized nodular synovitis is presented. The literature is reviewed with particular reference to the causes of ulnar tunnel syndrome, the uncertainty over the origin of this type of tumor, and its tendency to recur after incomplete excision.

Autoradiographic distribution of [3H](+)-pentazocine and [3H]1,3-di-o-tolylguanidine (DTG) binding sites in guinea pig brain: a comparative study

Binding studies suggested the selectivity of (+)-pentazocine for sigma receptors, and subsequent synthesis and testing of [3H](+)-pentazocine confirmed its high potency and selectivity for sigma sites. Newer data have demonstrated the selectivity of (+)-pentazocine for a subtype of the sigma receptor called sigma-1. Based on these findings, the distribution of [3H](+)-pentazocine binding sites in the guinea pig brain was examined using in vitro autoradiography. [3H](+)-Pentazocine binding was high in the cingulate cortex, dorsal diagonal band, periaqueductal gray, cerebellum and cranial nerve nuclei. It was relatively low in the nucleus accumbens, neocortical areas and caudate nucleus. A significant correlation was found between the binding of [3H](+)-pentazocine and [3H]1,3-di-o-tolylguanidine, a selective sigma ligand across brain regions. However, certain nuclei exhibited markedly different ratios of binding of the two ligands. Since DTG is not selective for the sigma subtypes, while (+)-pentazocine is selective for the sigma-1 type, the data are suggestive of relative differences in the distributions of sigma-1 and sigma-2 sites.

Cement burns and their treatment

Twenty patients with cement burns presenting to Stoke Mandeville Hospital Burns Unit between 1981 and 1989 are described. They represent 1.8 per cent of the total adult patients treated at this unit. Fifteen (75 per cent) had surgery for full thickness skin burns. A questionnaire sent to all the accident and emergency officers employed within the catchment area of the Burns Unit at Stoke Mandeville Hospital showed important gaps in their knowledge of the subject. It is suggested that further publicity be given to this uncommon but potentially serious injury.

Contact burns due to thermoplastic road paint

Thermoplastic road markings are used at similar temperatures to tar and bitumen and spillage onto skin causes similar contact burns. Most of these occupational burn injuries can be avoided by adherence to the manufacturer's recommendations about the wearing of protective clothing. Management and foremen of contractors using these materials need to ensure that their workers comply with safe procedures and wear the specified protective clothing.

Ritual burns--the Buddhist tradition

The mystical significance of fire is common to many cultures and religions. For the Buddhist community acts of self-mutilation by burning reflect a tradition for which the direct precedent is set in the ancient scriptures of the Lotus Sutra. Burns are produced by contact with incense and treated with oil and vegetable dressings. Two cases are presented and discussed with reference to early Buddhist beliefs.

Bonfire and barbecue burns

A 10-year retrospective study of burn injury associated with bonfires and barbecues was undertaken at a regional burns unit. Fifty-four patients were identified and their notes were reviewed. They represented 2.16 per cent of all burn admissions during this period.

Hand injuries from leading horses

An estimated 3.5 million people ride horses in the United Kingdom (Cannon, 1989). Injuries consequent to falls are common (Edixhoven et al., 1981), but those sustained while leading horses are less well recognized. In eight cases inappropriate grip of the reins or halter rope while leading a horse or pony resulted in an avulsion injury to a finger or thumb. It is suggested that people at risk be informed of such injuries.

Rupture of flexor pollicis longus as a complication of Colles' fracture: a case report

A case of flexor pollicis longus tendon rupture as a complication of a Colles' fracture in a 17-year-old male is described. Tendon repair by means of a one-stage tendon graft produced a good functional result.