Stress injury to the bone among women athletes.

Women's participation and recognition in sports have grown dramatically in the last 30 years, and this trend is expected to continue. In the last decade exciting research has centered on the unique medical and musculoskeletal aspects of the female athlete. Scientists have elucidated significant findings in the area of bone health, amenorrhea, disordered eating, osteoporosis, and stress fractures. Stress fractures are a common problem in female athletes and they appear to occur more commonly in the sacrum, pelvis, and femoral neck. Certain risk factors place women at a greater risk for stress injury to the bone, such as amenorrhea, low calcium intake, disordered eating, bone geometry, and leg length discrepancy. The best treatment for a stress fracture is prevention. Moreover, any woman with a stress fracture must be evaluated for the female athlete triad. Most stress fractures can be treated with relative rest and correction of the underlying factors that contributed to the injury. Certain stress fractures occur in areas of relative hypovascularity and are at risk for nonunion or avascular necrosis. In these cases surgery should be considered.

Traumatic osteochondral defect of the first metatarsal head: a case report.

Osteochondral injury of the first metatarsophalangeal joint is described in most literature as "osteochondritis dissecans" and an early stage of hallux rigidus. Traumatic osteochondral lesions of the knee and ankle are relatively common and well described. A case of a traumatic osteochondral defect of the first metatarsal head is presented.

Pediatric sports injuries: when to refer or x-ray.

When any athlete presents for evaluation of an injury, the history and physical examination is of paramount importance in establishing a differential diagnosis. A radiograph is often used to confirm a diagnosis or to reassess an injury following treatment failure. There are certain drawbacks involved with getting a radiograph including cost, inconvenience, radiation exposure, and misinterpretation. Therefore, the radiographic evaluation of the injured athlete should be used only as clinically necessary. The benefits of getting a radiograph, to allow assessment of the severity of the injury, and thereby allow a more appropriate and aggressive treatment and rehabilitation program. The skills of history taking and physical examination presented in this article should make it easier to decide when the child athlete needs a more comprehensive and aggressive evaluation including radiographic studies.

Glucose response to abrupt initiation and discontinuation of total parenteral nutrition.

Plasma glucose was studied during the initiation of total parenteral nutrition (TPN) and the discontinuation of TPN without a tapering schedule. Blood was sampled every 5 minutes for 2 hours after the start of TPN and 1 week later as TPN was discontinued. A total of 14 initiations and 14 discontinuations were studied in 18 patients. Severity of illness in patients ranged from stable condition postoperatively to multiple-system failure; six patients had diabetes mellitus. The TPN solution was a 3:1 admixture that provided a caloric intake equal to 1.2 times the resting energy expenditure, with 40% fat and 60% carbohydrate calories. An average of 1963 kcal was provided per day (340 g of glucose, 79 g of fat). During the initiation phase, the mean increase in plasma glucose was 60 mg/dL. The increase for diabetic patients was 79 +/- 14 mg/dL compared with 52 +/- 23 mg/dL for the nondiabetics. During the discontinuation phase, the mean plasma glucose decreased 40 +/- 20 mg/dL; two patients with high concentrations of regular insulin (50 and 100 units) showed an increase in plasma glucose when the TPN was stopped. Plasma glucose returned to the preinfusion baseline after discontinuation. During both initiation and discontinuation, plasma glucose showed little change after the first 60 minutes. No clinical symptoms of hypoglycemia were observed. In conclusion, TPN as a 3:1 admixture can be safely started as full nutrition support and stopped abruptly without a tapering schedule. Plasma glucose response is rapid, predictable, and mostly complete within 60 minutes.