Articles: health.
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J Orthop Sports Phys Ther · Jun 2001
ReviewStructure and function of the lumbar intervertebral disk in health, aging, and pathologic conditions.
This report is a comprehensive review of the basic and clinical science relating to the morphology and function of the intervertebral disc of the lumbar spine. The purpose is to review the anatomy, physiology, and biomechanics of the intervertebral disc of the lumbar spine in health, with aging, and in pathologic conditions. ⋯ These structural and biomechanical changes are related to degenerative changes that occur in association with aging and trauma. Knowledge of the gross morphology and ultrastructure of the intervertebral disc and pathobiologic processes underlying associated conditions is essential to orthopaedic practice.
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There has been a good deal of discussion and though on the notion of health. The most widely employed definitions can be termed "physiological", focusing on organs and normality. These definitions result from the development of medicine around the concept of disease, leading Boissier de Sauvages, author of a disease classification that continued to be used until the current classification proposed by the WHO, to state that "health, considered in its historical context, is the concourse of phenomena designating life and perfect structures". ⋯ Thus, as proposed by René Dubos, health is a "relatively trouble-free state devoid of suffering". We integrate the notions of handicap that we have developed in a four-dimensional approach where subjectivity plays a very important role. Our proposal totally changes the notion of cure: one can be diabetic and cured, paraplegic and cured.
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Dtsch. Med. Wochenschr. · Jan 2001
[Myocardial infarction and coronary artery ventricular fistulas due to blunt chest trauma]
An 18-year-old previously healthy, cigarette smoking man with no other risk factors for ischaemic heart disease, was admitted to hospital after being kicked in the chest by a horse. On arrival he complained about pain in the lower mediastinum. INVESTIGATIONS: The ECG showed sinus rhythm, right bundle branch block and convex bowed ST elevation in leads V1-V3. Sixty minutes after the incident the cardiac enzymes (creatinekinase-MB fraction, troponin I) were significantly raised. Despite an only slightly reduced left ventricular function documented by transthoracic echocardiography, SPECT-thallium scan showed large scintigraphic defects. Coronary heart disease was excluded by coronary angiography. Four small coronary-ventricular fistulas were identified. Laevocardiography showed a hypokinesia in the antero-septal region. DIAGNOSIS, TREATMENT AND COURSE: We assumed traumatic myocardial infarction of the anterior wall and rupture of multiple small coronary vessels, leading to coronary-ventricular fistulas. No interventional or surgical therapy was performed. Later on the left ventricular function became normal. Echocardiography merely outlined an akinetic scar in the middle of the septum. At exercise ECG test sixteen months later, the patient remained asymptomatic and was able to exercise without any signs of ischaemia up to a work load of 175 W. Furthermore, the fistulas could be seen by echocardiography. ⋯ Cardiac involvement should be considered in all cases of blunt chest trauma. In addition to a traumatic myocardial infarction fistulas may also, though rarely, occur. Myocardial scintigraphy after cardiac contusion is not suitable for diagnosing myocardial ischaemia or vitability.