By M. Yussuf. University of Nebraska, Lincoln. 2018.
Studies of this sort need to be conducted with large numbers of children purchase 5 mg compazine, of varying age and in a range of countries order 5 mg compazine otc, in or- der to help us to better understand at what age cross-cultural differences buy discount compazine 5mg on-line, if any buy compazine 5mg overnight delivery, become apparent and what changes take place during infancy, child- hood, and adolescence. They will also advance our understanding of the speed of cultural diffusion or adaptation. Pfefferbaum, Adams, and Aceves (1990) studied pain and anxiety in 37 Hispanic and 35 Anglo children with 166 ROLLMAN cancer at a hospital in Texas. It was the parents who differed, with the Hispanic parents reporting significantly higher levels of anxiety than the Anglo ones. Canadian-born Chinese and non-Chinese infants, receiving routine immu- nization at the age of 2 months, were compared for facial expressions and pain cries (Rosmus, Johnston, Chan-Yip, & Yang, 2000). This study is inter- esting because it provides an early examination of possible cultural differ- ences in socialization. The authors, noting a literature on cross-cultural dif- ferences in infant development and the role of infant-care practices, assessed demographic information, degree of acculturation, the infant’s feeding and crying patterns, and video recordings focused on the face dur- ing immunization. All babies exhibited facial and cry expressions, but the Chinese infants exhibited significantly greater brow bulges, duration of cry- ing, and number of cry bursts. Anecdotal evidence indicated that the Chi- nese mothers were more interactive during the waiting period, possibly in- creasing the infants’ arousal. The study is admittedly preliminary, but it opens the possibility that mothering patterns may either affect pain reactiv- ity directly or influence the overall arousal response. An interesting cross-cultural study was recently reported by Litcher et al. The used the Children’s Somatization In- ventory, which assesses the frequency and severity of a comprehensive set of physical complaints, to compare children in Nashville with a large group of 10- to 12-year-olds in Kyiv, Ukraine, including many who had been evacu- ated from Chernobyl after the nuclear power plant accident there. Remarkably, the Ukrainian children reported fewer physical symptoms than the Ameri- can ones of the same age, but their mothers reported nearly three times as many symptoms in their own children than those in Nashville. It is uncer- tain, of course, whether this reflects a generalized difference in awareness of bodily symptoms between American and Ukrainian women, developing at a later stage in life, or whether the Chernobyl incident fostered a more vigilant pattern in the latter group. Overall concern scores ranged from a high of 51 in Portugal to a low of 19 in Sweden, but the nature of the concerns also showed large inter-nation variability. Israeli patients were particularly con- cerned about pain and suffering whereas the Portuguese subjects worried about social stigma. Given the many behavioral consequences of chronic pain (McCracken, Zayfert, & Gross, 1992; Turk, Okifuji, Sinclair, & Starz, 1996), it is imperative to fully explore the sensory, affective, and cognitive reactions of pain patients, irrespective of ethnic background. ETHNOCULTURAL VARIATIONS IN PAIN 167 International studies of pain, particularly ones that focus on supposed ethnic or cultural differences, are influenced by differences in litigation or compensation systems in different countries. Hadjistavropoulos (1999), in a broad review of litigation and compensation, included a number of cross- cultural studies. Carron, DeGood, and Tait (1985), for example, found that back pain patients in the United States used more medication, experienced more disphoric mood states, and were more hampered in social-sexual, rec- reational, and vocational functioning than ones in New Zealand. In- dividuals in both countries who were receiving pretreatment compensation were less likely to report a return to full activity, although the relationship appeared more pronounced among those in the United States. Other studies that demonstrate that certain expensive interventions are more likely to reduce acute pain (e. Many of the published studies of ethnocultural factors and pain have made broad generalizations based upon exceedingly small sample sizes. Thomas and Rose (1991) asked 28 African Caribbean males and females, 28 Anglo-Saxons, and 28 Asians in London, England, who were having an ear pierced with a piercing gun, to complete the McGill Pain Questionnaire. Asian subject scores were nearly twice those of the African Caribbeans, with Anglo-Saxon scores nearly as high, leading them to con- clude, “the present results provide clear evidence that there are ethnic dif- ferences in pain experience in this test situation” (pp. Their subject pool consisted of 10 or 11 chronic low back pain pa- tients from each of the six countries. Likewise, Brena, Sanders, and Moto- yama (1990), evaluating 11 back pain patients from Tokyo and a like number of patients from Atlanta, reported, “Japanese low back pain patients were less psychosocially, vocationally, and avocationally impaired than similar American patients” (p. Sheffield, Kirby, Biles, and Sheps (1999) evaluated 124 Caucasians and 18 African Americans who had taken an exercise treadmill test which showed certain electrocardiographic abnormalities. Because 9 of the latter but only 34 of the former had angina during testing, they concluded, “African Ameri- 168 ROLLMAN cans reported anginal pain at twice the rate of Caucasians” (p.
A standard trephine (or core niques such as fat suppression and the effect of contrast trephine) used for removing broken screws is not suit- medium compazine 5mg on-line. In view of its superior performance in tissue tion buy cheap compazine 5mg, the biopsy material is thermally damaged as a result differentiation order compazine 5mg mastercard, the ability to evaluate the spread of the build-up of heat generic compazine 5 mg without a prescription, rendering it almost impossible of tumors in the soft tissues and bone marrow and to evaluate. More appropriate instruments are special their relationship with the major nerves and ves- trephines that transport the bone fragments outwards sels, an MRI scan is essential nowadays before the and that incorporate a special device for ejecting the surgical resection of any malignant bone and soft cylinder. On Because it is not possible to identify a benign lesion the other hand, a good result can usually be achieved solely on the basis of the history, clinical findings when such a trephine is used in cancellous bone. In and a conventional x-ray or sonogram, this certainly most cases, however, an open biopsy is indicated. Ex- does not mean that an expensive MRI scan is al- amination of a frozen section may reveal whether rep- ways indicated, particularly since it may not reveal resentative lesional tissue was biopsied, rather than the the diagnosis in any case. But in any more appropriate to send the patient, or at least case, frozen sections should only be evaluated by a pa- the images, to a colleague with more experience in thologist with considerable experience in bone tumor the diagnosis and treatment of bone tumors. Vessels and nerves are not contaminated by the provide the pathologist at least with general x-rays in biopsy. These tend to be located at the pe- knowledge of the x-ray findings may amount to mal- riphery of the tumor, where the most aggressive areas of practice, especially when cartilaginous tumors are being osteolysis are visible on the x-ray. Since bone tumors are usually mineralized, a should never be used to expose the bone. These are placed reliable histological assessment is often possible only after around the bone and are especially useful for retracting 4 decalcification several days after the biopsy. However, since the tip of the Hohmann diagnostic »rush jobs« for a restlessly waiting surgeon and retractor is rotated around the bone, tumor cells can be anesthetist can result in mistakes. Since, in any case, high- transported behind the bone, possibly promoting the grade malignant tumors are precisely the type that do not further spread of the tumor. At the end of the operation, locally aggressive, tumors (occasionally even for small any Redon drain must be inserted very carefully so as low-grade malignant tumors). This particularly applies to avoid contamination of any new compartments. The if the reconstruction does not pose any special problems drain should be pushed through the skin at a maximum or if the patient will not have to cope with any major distance of 10 mm from the end of, and aligned with, the drawbacks. The skin should be sutured not with transverse Needle biopsy is a simpler procedure for soft tissue interrupted sutures, but with an intracutaneous continu- tumors since no bone resistance has to be overcome. The biopsied tissue should always be unfixed But here, too, there is a considerable risk that insuf- and just slightly cooled (never frozen) as soon as possible ficient material is collected or that the sample is not (as for a frozen section) and forwarded to a competent representative. A sentinel node biopsy is indicated for pathologist by prior arrangement. Fixation in formalin malignant soft tissue tumors that metastasize into the can interfere with, or even make impossible, important lymph nodes (these include, in particular, synovial sar- diagnostic investigations (e. If malignant tumors are present, the biopsy pro- tumor sections cedure may result in contamination of the biopsy ▬ use of Hohmann retractors channel with malignant cells [11–12]. During tumor ▬ Redon drain far away from the incision resection, therefore, the biopsy channel must al- ▬ skin sutured with interrupted sutures ways be removed together with the tumor en bloc. For this reason, if a malignant tumor is suspected, the biopsy should always be performed in a hospital where the potentially necessary treat- Special aspects of the biopsy from the standpoint ment can also be provided. This unclear situation requires consultation, be- that the biopsy channel can be resected together with the fore the biopsy, between the clinician / radiologist and tumor en bloc. For this reason, the biopsy should never the pathologist to discuss the procedure to be adopted. If be performed via the traditional access routes (which are possible, this consultation process, including a discussion usually crossed by vessels and nerves), but always 1–2 cm of the radiographic findings, should clarify the following away, through the muscle proceeding directly to the bone. In addition to matrix formation (osteoid, The differential diagnostic ranking will produce vari- chondro-osteoid, hyaline cartilaginous or myxoid car- ous options for substantiating or ruling out clinical tilage matrix), the cellular composition of the lesion in conditions by means of additional investigations. An particular should be examined, and the pathologist will undifferentiated sarcoma, for example, can be identi- need to establish, whether any matrix is formed from fied as an osteosarcoma if enzyme histochemical tests tumor cells or whether e. However, this very immature, pseudosarcomatous new bone formation test can only be performed on unfixed tissue that is is involved. The same applies to molecular biologi- cells occur in numerous lesions and can frequently con- cal investigations and the detection of the transloca- fuse the diagnostician. Microbiological Pseudocystic, blood-filled cavities are also not neces- investigations should be arranged if osteomyelitis is sarily synonymous with the diagnosis of an aneurysmal suspected.
Imaging investigations Bone scan 4 While this highly sensitive buy compazine 5mg overnight delivery, though not very specific purchase 5 mg compazine, in- Conventional x-ray vestigation is not the first-line diagnostic technique generic 5 mg compazine with amex, it is ▬ If clinical examination shows a clearly visible defor- used if the following are suspected mity for which reduction under anesthesia is defi- osteomyelitis 5mg compazine sale, nitely indicated one projection plane will suffice. The CT scan with 3D reconstruction is suitable for visu- ▬ For shaft fractures the neighboring joints must also alizing complex fracture morphologies, particularly for be x-rayed at the same time. Additional views in internal complex pelvic fractures, and external rotation are helpful. There is a need, The disadvantages are the cost, the time involved and therefore, for alternative, less stressful and more cost-ef- the fact that children of preschool age can only undergo fective imaging investigations. These drawbacks have limited its more diation-free visualization of joint, epiphyseal and growth widespread use. Classification of fractures in children according to Salter and Harris. Type I and II lesions can also be described as »epiphyseal separations« or »shaft fractures«, and type III–V lesions as »epiphyseal fractures« or »joint lesions«. Type V (compression fracture) is initially undiagnosable tions of injuries that affect the growth plates and are not particularly helpful as regards the choice of treatment or prognosis. The most commonly used classification is that according to Salter-Harris (⊡ Fig. The original view that epiphysiolyses are not epiphy- seal fractures but involve a high risk of physeal closure, is no longer justified. Epiphysiolyses are not just rather more common, they also lead, depending on the anatomical Displacement site and the displacement at the time of the trauma, to Axis: Establish the deviation from the normal posi- physeal bridges in a high percentage of cases. For diaphyseal fractures: Measure the form arbitrarily, they are difficult to influence by treat- angle between the cortices of the main fragments and ment. Some authors strongly dispute the possibility that establish whether a varus/valgus deformity (AP plane) a physeal bridge forms after axial trauma and an initially and extension/flexion deformity are present. Nor does In metaphyseal fractures, tangents drawn on the joint this additional type serve as a decision-making aid since surfaces and knowledge of the physiological joint it involves a retrospective evaluation. Alternatively, if the epiphysis is widespread classifications of pediatric fractures are more not very ossified, a straight line is drawn through the comprehensive since they also include fractures outside growth plate. Arotational deformity can be recognized on the ra- the section with a radiologically clearly visible cortex diograph by means of the differing diameters of the and medullary cavity and tubular in cross-section. Only aphysis and that part of the growth plate on the shaft on the lower leg can rotation be quantified to a preci- side. Epiphyseal separations (Salter I and II) are clas- sion of 10° in a direct comparison with the other leg sified as metaphyseal fractures and run through the by determining the angle between the malleolar axis layer of hypertrophic chondrocytes ( Chapter 2. At femoral ▬ The epiphysis covers the section between the growth level, any rotational defects in the acute situation plate and the joint. Fractures in this part of the bone can be determined only after surgical stabilization by are termed epiphyseal fractures (Salter III and IV). The clavicle is the commonest site, followed by the hu- Not infrequently the diagnosis is made only several merus and femur. Shoulder dystocia, a high birth days after the birth when an obvious reduction in spon- weight and gestational age are risk factors [17, 20]. The expression »birth gist confirmed a sciatic nerve palsy and the x-ray showed 4 trauma« is not really appropriate in this case since a new bone formation in the area of the proximal medial neonatal clavicle will break under a load of 5–16 kg, femur. In and revealed a lesser trochanter avulsion, compatible with addition to a pain-related reduction in spontaneous sciatic neurapraxia caused by excessive vertical traction motor activity, a palpable, but not readily visible, on the leg during delivery. An asymmetrical startle reflex, and the fact that the neonate can only be breast-fed on one side are fur- 4. Since the findings are often minimal, Child abuse has many depressing facets, most commonly however, many of these fractures remain undetected. Particularly at risk are children in families distal end of the humerus and femur are completely with a low income/social status or single-parent families, cartilaginous at this stage. Any suspected fracture firstborns, unplanned children, stepchildren, premature needs to be confirmed sonographically, although infants, handicapped children and children of drug-de- even the sonogram does not always clarify the situ- pendent parents. In children under 1 year, 50% of the fractures are radiological course will provide a conclusive result for the result of abuse.
The above-mentioned André Venel also achieved pio- neering work in another field by establishing the world’s first orthopaedic institute in Orbe (Canton of Vaud order 5 mg compazine with visa, Swit- zerland) in 1780 order compazine 5 mg on line. This institute provided conservative treat- ment exclusively for children with orthopaedic conditions 5 mg compazine sale. Hans von Gersdorff: Corrective knee extension purchase 5mg compazine otc, from : Feldt- an orthopaedic hospital, in 1812 in Würzburg. In France, buch der Wundarztney, 1517 Jacques Mathieu Delpech founded an orthopaedic institute 20 Chapter 1 · General in 1825 in Montpellier, while Jules-René Guerin and Charles- 1 Gabriel Pravaz began their work in an orthopaedic hospital in Paris in 1826. Delpech (1777–1832) is also considered to be the actual founder of the science of orthopaedics. In England an orthopaedic institution was founded in 1837 by William Little. The first American orthopaedic institute was inaugurated in Boston in 1839 by John Paul Brown. Other important institutes were founded by Wilhelm Schulthess in Zurich, Switzerland (Wilhelm Schulthess Klinik and Balgrist Hospital) and the Riz- zoli Institute in Bologna, named for the orthopaedist Francesco Rizzoli and opened in 1896. Physical therapy is another form of treatment that was already known to the ancient world. Hippocrates was aware of this mechanical therapy, while Aesculapius and Galen recommended massages. Hydrotherapy and balneotherapy arrived from the Orient and were known to the ancient Greeks and Romans. In Central Europe, bath houses and bathing masters are even mentioned in legislative texts (Volksrechten) dating back to the 6th–8th centuries. The bathing masters, who also worked as barbers, subsequently adopted the role of surgeons. Electrotherapy was introduced in the 18th century with the discovery of electricity. The German doctor Daniel Gottlob Moritz Schreber refined these to produce a system of »medical gymnas- tics«. He also invented the allotment garden, which is known as a Schrebergarten in German-speaking countries. Friedrich Ludwig Jahn was the founder of an actual gym- nastics movement with a patriotic outlook (Die deutsche Turnkunst, 1816). Pehr Henrik Ling subsequently founded the »Swedish physical therapy« program, a dy- namic method that competed with the mechanical tech- niques of the time. Jonas Gustav Zander, on the other hand, developed various apparatuses for use in therapeu- tic exercises. Numerous institutes employing Zander’s machines were founded towards the end of the 19th century (⊡ Fig. Physical therapy in the current meaning of the term was developed towards the end of the 19th century with the support of the clinicians Theodor Billroth and Albert Hoffa. The pioneers also included Rudolf Klapp, who de- veloped a creeping treatment. Numerous physical therapy schools were formed in German-speaking countries. New therapeutic options for neuromuscular disorders were introduced in the 1950’s by H. Advertis- Hippotherapy for disabled children was also developed ing copy published at the end of the 19th century. This mutilating operation was neces- orthopaedics was the introduction of arthroscopy. Even in the Middle ginnings of this technique date back to Eugen Bircher (in Ages people realized that wound fever would lead to Aarau, Switzerland) in the 1920’s. A school for arthrosco- death if the injured limb was not amputated in time.