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LETTERS: Andrew D Cowley and Gregory Minnaar Watch out for Wii shoulder BMJ 2008; 336: 110-d [Full text]

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A previously described clinical injury

Julio Bonis   (24 February 2008)

Retroperitoneal Haemorrhage from Ruptured Angiomyolipoma while Playing Wii © Video Games

Joshua J Meeks, Neil Chungfat, Joshua J. Meeks, Christopher M. Gonzalez   (26 August 2008)

Wii-Related Pneumothorax

Adrian CH Low   (4 September 2008)

A previously described clinical injury 24 February 2008
Julio Bonis, Family Medicine Resident Fundación Jimenez Díaz, 28004, Madrid, Spain Send response to journal: Re: A previously described clinical injury	cowley and Minnar describe in their article a injury related with use of Wii videogame. First case of wiiitis (original term used to describe the wii shoulder) was described and suffered by myself in June 2007, as published in the New England Journal of Medicine. For that reason I think authors should have done a deeper review of previous literature about the issue and put a reference to the original article: Bonis J. Acute Wiiitis. N Engl J Med. 2007 Jun 7;356(23):2431-2. Dr Julio Bonis Competing interests: First author describing "wii shoulder"
Retroperitoneal Haemorrhage from Ruptured Angiomyolipoma while Playing Wii © Video Games 26 August 2008
Joshua J Meeks, Urology Resident, Northwestern University Chicago, IL, 60607, USA, Neil Chungfat, Joshua J. Meeks, Christopher M. Gonzalez Send response to journal: Re: Retroperitoneal Haemorrhage from Ruptured Angiomyolipoma while Playing Wii © Video Games	Haemorrhage of renal angiomyolipoma (AML) has classically been described as occurring spontaneously or associated with trauma. A young woman with a history of incidentally identified AML presented to the emergency department complaining of three to four days of discomfort. The patient reported playing the Wii © Sports video game aggressively when she experienced left-sided pain accompanied by lightheadedness, abdominal cramping, nausea and vomiting. In the emergency department, the patient was found to be tachycardic to a heart rate of 120 bpm and complained of light-headedness. Laboratory evaluation revealed a haemoglobin of 8.5 g/dl. A CT scan of her abdomen identified acute rupture of a 10 cm AML on the superior pole of the left kidney with associated active extravasation and a retroperitoneal haematoma. She was subsequently admitted for monitoring but the following morning her haemoglobin had dropped to 6.8 g/dl with persistent abdominal pain. She underwent angiography and catheter directed embolization of the mass with subsequent recovery. We believe this is the first case in which retroperitoneal haemorrhage has been linked to video game usage. Competing interests: None declared Editorial note The patient whose case is described has given her signed informed consent to publication.
Wii-Related Pneumothorax 4 September 2008
Adrian CH Low, Hospital Medical Officer Western Health, VIC, Australia Send response to journal: Re: Wii-Related Pneumothorax	A 46 year old man with approximately 25 pack-year smoking history presented to the Respiratory Department with right-sided primary spontaneous pneumothorax (PSP) following failed conservative management in the Emergency Department. There were no other relevant medical history or risk factors noted. However, his initial presentation was following an extended period playing Nintendo Wii sporting games (golf, tennis and bowling). There have been various reports of console-game related injuries since the introduction of interactive games simulating real-life sporting activities with Nintendo Wii. Majority of the reported injuries were repetitive strain injuries, soft tissue or articular injuries, and has been coined Wiiitis by other authors(1,2,3). Case reports of PSP in athletes are quite rare, and are usually associated with blunt chest trauma in contact sports(4). Given that the patient is a self-employed businessman and does not regularly play sports, Wii-related PSP may be the latest console-game related injury that needs to be suspected among the various presentations of Wiiitis. 1. Bonis J. Acute Wiiitis. NEJM 2007;356:2431-2432 (Correspondence letter) 2. Cowley A. Watch Out for Wii shoulder. BMJ 2008;336:110 (Correspondence letter) 3. Robinson RJ. Wii Knee. Emerg Radiol 2008;15(4):255-7 4. Kizer KW. Pulmonary air leaks resulting from outdoor sports. A clinical series and literature review. Am J Sports Med. 1999 Jul- Aug;27(4):517-20 Competing interests: None declared Editorial note The patient whose case is described has given his signed informed consent to publication.