Current physiotherapy practice in the management of tennis elbow: A service evaluation

BACKGROUND

Tennis elbow is a common painful condition that may affect daily function and ability to work. Physiotherapy is the most commonly used primary intervention but there is a wide range of treatment options within the umbrella of physiotherapy. Our aim was to report on the treatments that are currently used by physiotherapists in a UK National Health Service (NHS) setting.

METHODS

A retrospective service evaluation was conducted at two NHS hospital trusts by reviewing patient attendance records over a 1-year period. All patients with tennis elbow were included, except those referred for postoperative rehabilitation. Patient notes were analysed using a predefined assessment template.

RESULTS

A total of 65 patient records were identified, with patients having a mean age 48 years and mean symptom duration of 5.4 months. The mean treatment duration was 64 days, over 3.7 sessions. The most commonly used treatments were education and exercise, although the type and dosing of exercise varied greatly. Passive modalities such as ice, taping, manual therapy, acupuncture and electrotherapy were still used.

CONCLUSIONS

Wide variations in treatment approaches were identified. There was no consistency in the choice of modality used, the type of exercise or the dose of exercise prescribed. The use of passive modalities and corticosteroid injections was found to remain commonplace, despite a lack of supporting research evidence. There is a clear need for evidence-based guidance for physiotherapists treating patients with tennis elbow.

MnCl2 and MgCl2 for the removal of reactive dye Levafix Brilliant Blue EBRA from synthetic textile wastewaters: an adsorption/aggregation mechanism

Two divalent cation-based coagulants, magnesium chloride and manganese chloride, were used to treat synthetic textile wastewaters containing the azo-dye pigment Levafix Brilliant Blue EBRA. The jar-tests were performed in the presence or absence of auxiliary dyeing chemicals. They proved that (i) both divalent cation-based coagulants were effective in the treatment of those alkaline effluents, (ii) better performances in terms of color removal, residual turbidity, and settled volume, were achieved with manganese chloride, and (iii) the presence of dyeing auxiliaries significantly increases the required coagulant demand for treating the textile effluent. The dye removal mechanisms were investigated by combining observations of freeze-dried sediments with transmission electron microscopy coupled with energy-dispersive X-ray spectroscopy and selected area electron diffraction, Fourier transform infrared spectroscopy, adsorption experiments, and aggregates size measurements with a laser sizer under cyclic shear conditions. The results show that brucite (Mg(OH)(2)) particles are formed when applying MgCl(2) to the textile wastewaters, whereas a mixture of feitknechite (β-MnOOH) and hausmannite (Mn(3)O(4)) is obtained when using MnCl(2). More poorly crystallized particles are formed in presence of auxiliary dyeing chemicals. The adsorption experiments suggested that the azo-dye pigment adsorbs onto the surface of precipitating phases, whereas the aggregation dynamics indicated that a charge-neutralization mechanism underlies the formation of aggregates. The dye removal is then consistent with a precipitation/adsorption mechanism.

CT assessment of woodworkers' nasal adenocarcinomas confirms the origin in the olfactory cleft

BACKGROUND AND PURPOSE

Endoscopic endonasal surgery let us observe that woodworkers' nasal adenocarcinomas originate in the olfactory cleft. Our aim was the identification of CT imaging features that corroborate the olfactory cleft as the site of origin for woodworkers' adenocarcinoma.

MATERIALS AND METHODS

We designed a retrospective study to compare CT scans of 27 unilateral olfactory cleft adenocarcinomas with 30 cases of nasosinusal polyposis (NSP) and 33 healthy sinus controls. Enlargement of the olfactory cleft, lateralization of the ethmoidal turbinate wall, and contralateral bulging of the nasal septum were measured on coronal scans passing through crista galli and posterior half of both ocular globes. Comparisons have been performed by using analysis of variance and the Bonferroni procedure.

RESULTS

The nasal septum was significantly bulging across the midline in adenocarcinoma (4.6 +/- 3 mm; range, -0.1-13.7 mm) compared with NSP (0.7 +/- 1 mm; range, -2.1-2.3 mm) or healthy sinus controls (0.5 +/- 1 mm; range, -1.2-2 mm) (P < .001). The olfactory cleft was significantly wider in adenocarcinoma (15.1 +/- 4.5 mm; range, 8.6-25.7 mm) than in NSP (3.6 +/- 0.4 mm; range, 2.8-4.6 mm) or healthy sinus controls (3.3 +/- 0.7 mm; range, 1.4-4.6 mm). The ethmoidal labyrinth width was significantly smaller on the pathologic side in adenocarcinoma (7.2 +/- 2.7 mm; range, 3.2-14.2 mm) than in the control groups (P < .001). Whereas the angle between the conchal lamina and vertical midline was close to zero degrees in NSP (0.03 +/- 2.25 degrees ; range, -5 degrees -3 degrees ) and healthy sinus controls (0.45 +/- 2.13 degrees , range, -5 degrees -5 degrees ), it reached 39.76 +/- 13.83 degrees (P < .001) in adenocarcinoma.

CONCLUSIONS

Radiologists should suspect nasal adenocarcinoma on sinus CT scans showing a unilateral expanding opacity of the olfactory cavity.

Color removal from acid and reactive dye solutions by electrocoagulation and electrocoagulation/adsorption processes

In this study, electrocoagulation of Marine Blue Erionyl MR (acid dye) and electrocoagulation followed by adsorption of Brilliant Blue Levafix E-BRA (reactive dye) from aqueous solutions were investigated, using aluminum electrodes and granular activated carbon (GAC). In the electrocoagulation and adsorption of dyestuff solutions, the effects of current density, loading charge, pH, conductivity, stirring velocity, contact time, and GAC concentration were examined. The optimum conditions for the electrocoagulation process were identified as loading charges 7.46 and 1.49 F/m3, for a maximum abatement of 200 mg/L reactive and acid dye, respectively. The residual reactive dye concentration was completely removed with 700 mg/L GAC. The results of this investigation provide important data for the development of a combined process to remove significant concentrations of recalcitrant dyes from water, using moderate activated carbon energy and aluminum consumption, and thereby lowering the cost of treatment.

[Woodworker's nasal adenocarcinoma revealed by anosmia]

OBJECTIVES

The aim of this article is to report two cases illustrating the origin of woodworkers' adenocarcinoma in the olfactory cleft and to discuss screening, prevention, and surgical approaches.

MATERIAL AND METHOD

Retrospective study of the charts of two cases of adenocarcinoma of the olfactory cleft revealed by a loss of the sense of smell.

RESULTS

Of 30 consecutive cases of woodworkers' adenocarcinoma of the olfactory cleft observed during the last 3 years, the two cases revealed by anosmia were diagnosed as small tumors located in one olfactory cleft.

CONCLUSION

In light of these two cases, we discuss anosmia in the diagnostic screening of this tumor and its consequences in the olfactory cleft: flexible endoscopic examination of the olfactory cleft seems preferable to rigid endoscope examination of the middle meatus at screening; endoscopic resection of the olfactory cleft seems preferable to resection through external approaches; and nasal lavages seem preferable to the Proetz technique for preventive sinus lavage. The new knowledge on adenocarcinoma of the olfactory cleft should be familiar to occupational health physicians, general practitioners, and otorhinolaryngologists because of its practical consequences for screening, diagnosis, prevention, and surgical treatment.

[Aneurysmal bone cyst of the ethmoid: paralateronasal or endoscopic surgery? Case report]

AIM

To report a typical case operated on under endonasal endoscopic surgery.

CASE REPORT

A 20 year old girl came to the clinic with a left eye exophtalmus. Nasal endoscopy revealed a tumour developped into the left nasal fossa. Imaging allowed to suspect an ethmoidal aneurysmal cyst. CT showed a large tumour involving the left ethmoid, extending into the frontal and maxillary sinuses, with a fluid level in the middle of the tumour. MRI eliminated intracranial extension, showed a cystic component in the middle of the tumour and the presence of hemosiderin signals on T2. Complete resection of the tumour was performed under endoscopic endonasal surgery thanks to a cleavage plane between tumour periorbit and dura. Follow-up was simple with no recurrence at 2 years.

CONCLUSION

Despite its rarity, this tumour needs to be known by ENT surgeons, and our surgical experience demonstrates that it can be resected endoscopically.

Élimination des colorants des eaux résiduaires de l'industrie textile par la bentonite et des sels d'aluminium

L'industrie textile utilise des colorants de synthèse toxiques qui polluent ses eaux résiduaires avec, parfois, des flux importants. Les procédés traditionnels les éliminent mal : ils sont peu iodégradables et la seule floculation, par exemple par des sels de fer, donne des résultats insuffisants. Or, en Algérie, la réutilisation agricole des eaux usées même industrielles est devenue une impérieuse nécessité. Le procédé proposé repose sur l'utilisation de sels d'aluminium ou, mieux encore, un polyhydroxyaluminium, associés à une bentonite de forage très fine présentant l'avantage d'être localement disponible et peu coûteuse. Quatre colorants ont été testés. Ils appartiennent à deux grandes familles : les colorants acides d'une part, Jaune Supranol 4GL et Vert Nylomine C8B et les colorants dispersifs d'autre part, Rouge Foron RDGL et Violet Foron S3RL. Les essais montrent que, si la bentonite seule ou les sels d'aluminium seuls présentent des efficacités insuffisantes, ces derniers du fait d'une mauvaise décantabilité des microflocs formés, l'association bentonite-aluminium permet d'éliminer les colorants en quasi totalité avec une excellente décantabilité. Les concentrations optimales à mettre en oeuvre sont relativement basses, de l'ordre de 13 mg/l de Al3+ et 250 mg/l de bentonite. Les coûts d'exploitation sont donc très raisonnables. Sur un effluent industriel réel, le procédé permet de passer d'une DCO de 770 mg/l à moins de 30 mg/l.

Sorption study of an acid dye from an aqueous solutions using modified clays

The removal of the pollutant Supranol Yellow 4GL (S.Y.4GL) was studied by using different clays: clay exchanged with sodium (BNa+) and hydroxyaluminic polycation pillared clays in the presence or absence of non-ionic surfactant. While decomposing the surfactant at 500 degrees C, the surface of the clay changed significantly. The study of the behaviour of the three clays with respect to coloring solutions, allowed to determine the equilibrium time and the rate-determining step of the dye S.Y.4GL adsorption. Two simplified kinetic models, were tested to investigate the adsorption mechanisms in terms of pseudo-first order and pseudo-second order equations. Besides, the adsorption capacity data were fitted to Langmuir and Freundlich equations as well. A better fixation was obtained with an acidic pH. The effect of temperature on the adsorption of dye has been also studied and the thermodynamic parameters DeltaG degrees , DeltaH degrees and DeltaS degrees were determined.

Equilibrium and kinetics of color removal from dye solutions with bentonite and polyaluminum hydroxide

Wastewater from the textile industry contains soluble dyes that are toxic and particularly difficult to remove. A promising low-cost treatment, however, is use of polyaluminum hydroxide associated with bentonite. At suitable conditions, this process is able to efficiently remove color from solutions containing mixtures of soluble acid azo dyes and produce easily settleable sludge. The removal mechanism, which is believed to involve adsorption or precipitation and weak pH variations, is not well understood. With the overall reaction being second order, two elementary first-order reactions could be assumed. The equilibrium removal is a decreasing function of the temperature. However, this effect is weak and decreases when the dye concentration increases. At usual values of concentration in textile wastewater, this effect can be neglected. The resulting solid compound is particularly resistant to mechanical stress. Moreover, color was significantly released at pH greater than 8. Sodium ions have no influence on the compound stability, which reinforces the assumption of the involvement of an adsorption process.