E. Nemrok. Marywood University.

RENAL Bladder rupture may be intra- or extra-peritoneal and is usually associated with pelvic fracture generic motilium 10 mg mastercard. A blow to the cling and presents with abrupt onset of urinary fre- flank or abdomen produces a coup or countercoup quency generic motilium 10mg amex, diminished urinary stream, nocturia, and mechanism of injury. Bladder contu- Kidney injuries are divided into 5 classes based on sions are treated with catheter drainage for a few days. Class II: Cortical laceration Class III: Caliceal laceration Class IV: Complete renal fracture—rare sports injury GENITALIA Class V: Vascular pedicle injury—again, rare in sports Flank pain or gross hematuria after blunt trauma in an Genital trauma may occur in any sport, though it’s athlete requires consideration of possible renal injury. Gross or microscopic hematuria is present Testicular injuries result from direct trauma and in greater than 95% of renal trauma. Other urologic emergency requiring surgical management if sports to include in this category are basketball, the testis is to be salvaged. The penis majority of sports-related eye injuries (Napier et al, may be injured in straddle-type injuries or by direct 1996). Irritation of the pudendal nerve in bicycle racers can cause priapism or ischemic neuropathy of the penis. Symptoms usually resolve once the race PREPARTICIPATION PHYSICAL is over. EXAMINATION Penile frostbite occurs in runners who wear inade- quate clothing in extremely cold conditions. Gerstenbluth RE, Spirnak JP, Elder JS: Sports participation and using protective eyewear, participating in sports high grade renal injuries in children. McAleer IM, Kaplan GW, Lo Sasso BE: Renal and testis injuries BASICS OF THE EYE EXAMINATION in team sports. Nattiv A, Puffer JC, Green GA: Lifestyle and health risks of col- HISTORY legiate athletes: A multi-center study. Sagalowsky AI, Peters PC: Genitourinary Trauma, in Walsh PC, The history should include a detailed description of Retik, AB, Vaughan ED, Jr, et al (eds. It is also crit- EPIDEMIOLOGY ical to perform a thorough examination, and not solely focus on the obvious area of involvement.

Even though the results pentry term used to describe a joint made by notching described in a comparative study by these authors were the ends of two pieces and fastening them together so better than with other procedures purchase motilium 10 mg online, we remain very reserved that they overlap) about a method that involves the stiffening of a joint in ado- ▬ opening wedge osteotomy of the medial cuneiform motilium 10 mg on-line, lescents. On the other hand, the scarf osteotomy and the ▬ transfer of the adductor hallucis muscle from the Mitchell procedure are becoming increasingly popular [3, proximal phalanx to the 1st metatarsal (operation ac- 11, 13, 14, 15]. There is no doubt that very impressive ana- cording to McBride), tomical corrections can be achieved with these methods. Occasionally to walk without moving the toe joint during the heel-to- this complication ends in arthrodesis of the metatarso- toe roll. It should therefore be borne in mind that We would specifically warn against overcorrection. Schematic view of the surgical correction of juvenile valgization osteotomy of the metatarsal is performed in the horizontal hallux valgus. The adductor hallucis muscle is detached from the base plane (Scarf osteotomy). If the base of the proximal phalanx is very slant- of the proximal phalanx and fixed to the head of the 1st metatarsal ing or the distal phalanx shows pronounced valgus deviation, an Akin (operation according to McBride). In addition, the pseudoexostosis on the osteotomy of the proximal phalanx is also performed. DP and lateral x-rays of the left foot of a 15-year old girl with juvenile hallux valgus. Peterson MA, Newman SR (1993) Adolescent bunion deformity with double osteotomy and longitudinal pin fixation of the first Operations that are usually performed on adults, with ray. J Pediatr Orthop 13: 80–4 resection of the base of the proximal phalanx or the 15. Schwitalle M, Karbowski A, Eckardt A (1998) Hallux valgus in metatarsal head, are never indicated for adolescents and young patients: comparison of soft-tissue realignment and meta- are reserved for conditions in which substantial arthrosis tarsal osteotomy.

In order to consider pain measurement from a developmental perspective there need to be direct comparative studies between young and older adults purchase 10 mg motilium with amex. There is no literature on age differ- ences in pain assessment purchase 10mg motilium overnight delivery, although issues of measurement reliability and 136 GIBSON AND CHAMBERS validity have been investigated within specific age segments of the adult population. Evidence from a variety of sources would suggest that any measure- ment approach found to be useful in young adult populations, also has a potential for use with most older persons (Helme & Gibson, 1998; Parmelee, 1994). Single-item scales of self-reported pain intensity, such as verbal descriptor scales, numeric rating scales, colored analogue scales, and the pictorial pain faces scale, have all been shown to possess some at- tributes of validity and reliability when used with healthy older adults and even in those with mild cognitive impairment (Benesh, Szigeti, & Ferraro, 1997; Chibnall & Tait, 2001; Cook, Niven, & Downs, 1999; Corran, Helme, & Gibson, 1991; Ferrell, 1995; Gloth, 2000; Helme et al. Visual an- alogue scales (VAS) also have some evidence of validity (Scherder & Bouma, 2000), although several others have raised concerns about the suitability of this measure for use with older patients (Benesh et al. In particular, it has been suggested that older persons may have difficulties with the more abstract nature of the visual analogue scale scaling proper- ties (Herr et al. However, most data would support the use of such instruments in older adults with and without cognitive impairment (Corran et al. Some older persons will suffer from multiple comorbid medical illnesses, physical impairments in vision or hearing, severe cognitive impairment, or difficulties with verbal communication skills, all of which may complicate routine psychometric pain assessment. Behavioral–observational meas- ures of pain can bypass many of these difficulties and have been examined for use in frail older populations (e. Interrater reliability and concurrent va- lidity appear to be adequate in older nursing home residents, including those with mild to moderate cognitive impairment (Kovach, Griffie, Matson, & Muchka, 1999; Simons & Malabar, 1995; Weiner et al. However, the level of agreement between resident and staff perceptions of pain as indexed by behavioral markers has been shown to be relatively poor (kappa. A related ap- proach involves measurement of discrete facial expressions as nonverbal indicators of pain (Craig, Prkachin, & Grunau, 2001). A characteristic pain face has been noted (including lowered eyebrows, raised cheeks, closed eyes, parting or tightening of lips), and despite some individual differences, this expression is instantly recognizable by other third-party observers.