Baastrup’s disease is a rare, often misdiagnosed, and causes back pain in children. It is characterized by degenerative changes of both spinous processes and interspinous soft tissues between two adjacent vertebrae. Repetitive spinal movements in the sagittal plane predispose injury to posterior elements of the spine. Chronic flexion and extension strain the interspinous ligament, causing the neighboring spinous processes to adjoin. Patients typically report midline back pain in the lumbar region, which radiates both cephalad and caudad but not laterally. Pain is aggravated by extension and palpation and is alleviated with flexion. Some children with Baastrup’s do not experience pain but present with swelling along the spinous processes. Diagnosis is dependent on distinctive radiologic findings and exam features. Increased interspinous spaces and bone remodeling may be observed. While the current treatment for pain associated with Baastrup’s is directed towards physical therapy, massage therapy, nonsteroidal anti-inflammatory medications, muscle relaxants, and rest from activity, this is the first report of children undergoing interventional modalities for the treatment of back pain associated with Baastrup’s disease. We present two unique pediatric cases of female gymnasts with Baastrup’s disease who were successfully treated by two different techniques: interspinous ligament injection and medial branch block.
There is evidence of an unmet need for improved ward round documentation in our acute frailty unit. In this setting, it is feasible to introduce and rapidly adopt a structured ward round pro forma reflective of national guidelines. We aim to institute sustainable change through ongoing education and development of an electronic record-based pro forma. ■
<p>Climatic changes are exacerbating the risk of alpine mass movements for example through more frequent and extreme heavy precipitation events. To cope with this situation, the monitoring, anticipation, and early warning of rock slope failures based on process dynamics is a key strategy for alpine communities. However, only investigating the release area of an imminent event is insufficient, as the primary hazard can trigger or increase secondary hazards like debris flows or the damming of a river. Nevertheless, recent case studies dealing with successive hazards are rarely existent for the Calcareous Alps. In this study, we precisely investigate the cascading effects resulting from an imminent rock fall and perform a pre-event analysis instead of back-modelling of a past event.</p><p>The Hochvogel summit (2592 m&#160;a.s.l., Allg&#228;u Alps, Germany/Austria) is divided by several pronounced clefts that separate multiple instable blocks. 3D-UAV point clouds reveal a potentially instable mass of 260,000&#160;m&#179; in six main subunits. From our near real time monitoring system (Leinauer et al. 2020), we know that some cracks are opening at faster pace and react differently to heavy rainfall, making a successive failure of subunits likely. However, pre-deformations are not yet pronounced enough to decide on the exact expected volume whereas secondary effects are likely as the preparing rock fall mass will be deposited into highly debris-loaded channels. Therefore, we developed different rock fall scenarios from the gathered monitoring information, which we implemented into a RAMMS modelling of secondary debris flows. To obtain best- and worst-case results, each scenario is calculated with different erosion parameters in the runout channel. The models are calibrated with a well-documented debris flow event at Ro&#223;bichelgraben (10&#160;km NW and similar lithology) and are supported by field investigations in the runout channel including electrical resistivity tomography profiles (ERT) for determination of the depth of erodible material as well as a drone survey for mapping the area and the generation of an elevation model.</p><p>Here we show a comprehensive scenario-based assessment for anticipating cascading risks at the Hochvogel from initial rock failure volume estimation to debris flow evolution and potential river damming. This recent case study from an alpine calcareous peak is an excellent and rare chance to gain insights into cascading risks modelling and an improved hazard evaluation.</p>
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