Concussions and Contracts: The National Football League's Limitations to Protecting Its Players from Chronic Traumatic Encephalopathy

Chronic Traumatic Encephalopathy (CTE) is a neurodegenerative brain injury that has become prevalent among high-contact professional sports, especially American football. More and more retired players are exhibiting symptoms of CTE and being diagnosed with CTE post-mortem. While the neuroscience community constantly releases studies showing a causal connection between brain trauma and CTE, the National Football League (NFL) continues to deny that any brain injury can arise from playing football. The NFL must implement provisions in their contracts to fully inform and protect players from this lethal brain injury. This article examines the repercussions of CTE, how players' contracts do and do not provide protections, and the possible provisions the NFL can implement in its contracts to adequately protect players of repeated brain trauma.

Therapeutic efficacy of extended release oxybutynin chloride, and immediate release and long acting tolterodine tartrate in children with diurnal urinary incontinence

PURPOSE

We compare the tolerability and efficacy of extended release oxybutynin chloride, and immediate release and long acting tolterodine tartrate in children with nonneurogenic diurnal urinary incontinence and symptoms of overactive bladder.

MATERIALS AND METHODS

Children with a history of diurnal urinary incontinence were arbitrarily assigned to extended release oxybutynin, immediate release tolterodine or long acting tolterodine. The dose was titrated until effective (onset of complete diurnal urinary continence), maximal recommended dosage was achieved or bothersome anticholinergic side effects developed. An independent observer recorded the dose used, anticholinergic side effects and efficacy of therapy (incidence of urinary frequency, urgency, posturing and urinary incontinence).

RESULTS

The study included 86 girls and 46 boys. There were no statistically significant differences among the 3 treatment groups regarding the presence of peripheral or central nervous system anticholinergic side effects. Extended release oxybutynin and long acting tolterodine were significantly more effective at reducing daytime urinary incontinence than immediate release tolterodine (p <0.01 and 0 <0.05, respectively). Extended release oxybutynin was significantly more effective then long acting tolterodine for complete resolution of diurnal incontinence (p <0.05).

CONCLUSIONS

Extended release oxybutynin and long acting tolterodine are more effective than immediate release tolterodine in decreasing diurnal urinary incontinence. Extended release oxybutynin chloride is more effective than either immediate or long acting tolterodine for control of daytime urinary incontinence and urinary frequency.

Therapeutic efficacy of extended release oxybutynin chloride, and immediate release and long acting tolterodine tartrate in children with diurnal urinary incontinence

PURPOSE

We compare the tolerability and efficacy of extended release oxybutynin chloride, and immediate release and long acting tolterodine tartrate in children with nonneurogenic diurnal urinary incontinence and symptoms of overactive bladder.

MATERIALS AND METHODS

Children with a history of diurnal urinary incontinence were arbitrarily assigned to extended release oxybutynin, immediate release tolterodine or long acting tolterodine. The dose was titrated until effective (onset of complete diurnal urinary continence), maximal recommended dosage was achieved or bothersome anticholinergic side effects developed. An independent observer recorded the dose used, anticholinergic side effects and efficacy of therapy (incidence of urinary frequency, urgency, posturing and urinary incontinence).

RESULTS

The study included 86 girls and 46 boys. There were no statistically significant differences among the 3 treatment groups regarding the presence of peripheral or central nervous system anticholinergic side effects. Extended release oxybutynin and long acting tolterodine were significantly more effective at reducing daytime urinary incontinence than immediate release tolterodine (p <0.01 and 0 <0.05, respectively). Extended release oxybutynin was significantly more effective then long acting tolterodine for complete resolution of diurnal incontinence (p <0.05).

CONCLUSIONS

Extended release oxybutynin and long acting tolterodine are more effective than immediate release tolterodine in decreasing diurnal urinary incontinence. Extended release oxybutynin chloride is more effective than either immediate or long acting tolterodine for control of daytime urinary incontinence and urinary frequency.

Extracorporeal shock wave lithotripsy for calcified ureteral stent

Calcification of a ureteral stent has been an unusual complication of long-term stent use for bypassing ureteral obstruction or after surgical repair. Open or percutaneous procedures have usually been required to remove the calcification before the stent can be extracted. We report six cases of calcified ureteral stents successfully managed by extracorporeal shock wave lithotripsy (SWL) followed by cystoscopic extraction, thus avoiding open or percutaneous procedures.

Adult Wilms' tumor. Intraoperative cytology and ancillary studies performed in a case as an adjunct to the histologic diagnosis

A case of blastema-predominant Wilms' tumor in a 64-year-old woman is reported. Intraoperative cytology of a renal mass was used to rule out malignant lymphoma and neuroendocrine carcinoma. Light and electron microscopy, immunocytochemical staining and flow cytometry (FCM) were also performed. Immunoperoxidase studies of smears showed positive staining for vimentin and negative staining for cytokeratins and epithelial membrane antigen. FCM DNA analysis of paraffin-embedded tissue showed no aneuploid peak. Frozen section interpretation of such tumors as seen in this case may be difficult, requiring distinction among several small-blue-cell neoplasms, including Wilms' tumor, neuroendocrine carcinoma and malignant lymphoma; intraoperative cytology can provide a valuable adjunct to frozen section diagnosis.

Bilateral testicular injury from external trauma

Among 79 patients with testicular injury as a result of external trauma 5 had bilateral injury. Such injury occurred in only 1 of 66 patients (1.5 per cent) with blunt trauma versus 4 of 13 (31 per cent) with penetrating trauma. Bilateral ruptures were managed by bilateral partial orchiectomy in 2 cases, and orchiectomy with contralateral débridement and suturing in 1. Of 2 patients with unilateral rupture and contralateral contusion the contusions were treated by evacuation of the hematoma and the ruptures were managed by orchiectomy in 1 and partial orchiectomy in the other. Four patients were available for followup. One patient was hormonally anorchid but he obtained normal erections with testosterone cypionate, 1 had normal serum testosterone concentrations but borderline normal semen analysis, and 1 had reduced erections and borderline normal semen. The remaining patient had normal erections and no semen analysis was performed. The nature of the injury rather than the type of treatment appears to be the primary determinant of the outcome in these cases.