By Q. Shakyor. Marywood University.
Methods The Ovid version of Medline from 1960 to 2001 was searched for papers relating to testicular and renal trauma discount prandin 0.5 mg on line. Papers were sought using the words renal trauma buy prandin 1mg online, kidney trauma, renal injury, kidney injury, testicle trauma, testis trauma, testicle injury, testis injury and solitary organ. These were also linked to the words sport, football and skiing. Results Incidence Renal trauma Renal trauma is sustained in approximately 10% of all abdominal injuries and blunt injury is the cause of renal trauma in 90% of cases. In sports the vast majority of renal trauma is blunt trauma. In most cases injuries can be managed conservatively with surgery usually being reserved for: • vascular (renal pedicle) injury • shattered kidney • expanding or pulsatile haematoma • shocked polytrauma patient. Major renal trauma is more often associated with penetrating trauma than with blunt trauma (40% vs 15%). One must adopt a high level of suspicion for renal injuries in patients with major blunt 118 Should you play sport with one kidney, one testis? About 9% of individuals suffering renal trauma will require surgical exploration. Of these there is on average an 11% nephrectomy rate although most nephrectomies are for haemorrhage, with 61% of nephrectomies being for renovascular injury. Injuries are usually sustained in conjunction with other major injuries which is not the typical pattern of renal trauma sustained in sport. Renal trauma during sport is more commonly sustained as isolated trauma rather than in conjunction with other major injuries. Estimates of the incidence of blunt renal trauma are given at about 6⋅2 per 100 000 of the population with motor vehicle collisions making up the majority of causes.
Children who are able to sit at regular desks often feel more included with their peers in the classroom 2 mg prandin mastercard. However 2mg prandin visa, for children who are unable to sup- port themselves and do not have good trunk stability, there is often decreased functional ability for fine motor skills, such as writing. For children who are between definitely needing the trunk support and definitely being able to sit 232 Cerebral Palsy Management A Figure 6. There are many variation of adaptive toilets seats available; however, toilet training is difficult if the child does not at a desk, there is some advantage of them doing both. In this situation, chil- have a comfortable seating chair. Some de- dren will spend some time sitting at the desk to stimulate balance and trunk vices are stand-alone potty chair designs with control mechanisms, and then will spend time sitting in the wheelchair work- armrests and foot supports (A), while others ing on fine motor skills. Good trunk stability im- parted by armrests is important and, for some Floor Positioning Devices children, is all that is required (C). Individuals with severe quadriplegic pattern involvement with no head or trunk control need some position changes throughout the day. These position changes should include getting children out of the wheelchair into different lying positions, such as side lying and prone positioning (see Figure 6. These individuals often need pillows or supports for side lying and prone lying. Wedges are often helpful to position these children into the prone po- sition, which allows them to still have interaction with others in the room. These lying supports are most beneficial in school environments; however, some parents find them helpful in the home environment as well.
