Rugby football.

Rugby union football continues to gain in popularity in the United States. Both men's and women's clubs have been established at several colleges and universities. There has been substantial growth in the number of high school rugby football clubs in recent years. With the increase in numbers of young participants in this sport, it is important that great efforts be mounted to attempt to control the injury rates and severity of injuries in rugby football. Players and coaches must be knowledgeable of the rules of the game, and referees must strictly enforce these rules. Physicians and dentists should be involved in educating parents, coaches, players, and school officials about the inherent risks of injury and the means for injury prevention. Medical personnel must also be instrumental in educating players about alcohol abuse/addiction. Rugby players should be encouraged to use the limited protective gear that is allowed: wraps, tape, joint sleeves, scrum caps, and facial grease to prevent lacerations. Mouthguards are strongly recommended at any level of play and should be mandated. The use of helmets, face masks, and shoulder pads has been suggested by some authors. Such rule changes could actually increase injury rates and severity, because this equipment could be used as weapons as they are in American football. It is recommended that rugby clubs purchase or build equipment to practice scrummage skills. Coaches should be experienced and attend clinics or complete video courses on medical emergencies and safe techniques of the game. Injury frequency and severity can be decreased by adequate preseason training and conditioning, proper tackling and falling techniques, strengthening of neck muscles, and allowing only experienced, fit athletes to play in the front row. Medical surveillance must be improved at matches and, ideally, at practice sessions. At present, it is common for no emergency medical personnel or physicians to be present at matches in the United States. Better case registers are necessary to monitor rugby injuries, but more medical professionals must become involved in the sport to obtain useful data. Rugby players will respect the advice of a medical adviser, providing he or she is knowledgeable. This is a hardy group of athletes with a cavalier attitude, as evidenced by the injury statistics and the case studies above. Their sport can be made safer without diminishing the intensity of the game or the camaraderie the players enjoy.

Great toe sesamoid injuries in the athlete.

Rare, but potentially debilitating, injuries in the athlete may originate from trauma to the sesamoid bones of the great toe. Controlled studies comparing conservative versus surgical treatment outcomes are lacking owing to the limited number of suspected and proven cases of sesamoid stress fracture or sesamoiditis, a nondescript, painful condition involving the sesamoid. Thus, familiarity with the anatomy and congenital variations of the sesamoid is necessary to identify possible pathology in this area. Existing studies of surgical and nonsurgical treatment of athletes with great toe sesamoid injuries are reviewed.

Complications of intracavernous injections and penile prostheses in spinal cord injured men.

Erectile dysfunction is a common complication in men who have had spinal cord injury (SCI). This retrospective study focuses on the complications encountered at our institution with both penile prostheses and intracavernous injections in men with SCI. Seventy-two men with SCI were treated with intracavernous injections for erectile dysfunction, and 30 penile prostheses were implanted in 19 men with SCI. Twenty-two of the 72 patients in the intracavernous injection program had adverse effects; none were severe. Prolonged erections lasting four to six hours and ecchymosis were the most common complications. No complication required discontinuation of treatment. There were 23 inflatable prostheses and seven semirigid rods. Mechanical failures occurred in 15 instances, infection occurred in nine, and late erosion occurred in three. Although multiple revisions and replacements were necessary, 14 of the 19 patients had satisfactorily functioning implants at their last outpatient visit. Patients were selected carefully for penile implant placement and yet significant complications and expense were incurred to obtain satisfactory results. Although follow-up has been relatively short, the intracavernous injections of vasoactive medications appear to be a more attractive initial means of treating the erectile dysfunction in men with SCI. The complications are relatively minor and the incidence of prolonged erections has decreased with increased experience. Furthermore, the cost of treatment will be considerably less than that with implant surgery, particularly in view of the high drop-out rate. Although improved implants have decreased the occurrences of mechanical failure, it seems likely that infection and extrusion will continue to be significant problems among men with SCI.

The use of methotrexate in polymyalgia rheumatica.

OBJECTIVE: To examine the efficacy and steroid sparing potential of methotrexate (MTX) in the treatment of polymyalgia rheumatica (PMR) without giant cell arteritis. METHODS: 43 patients with PMR were treated with MTX 7.5 mg/wk for 3 months. This dose was raised to 10 and finally 12.5 mg/wk MTX if the desired response was not obtained. RESULTS: No patient benefitted clinically or statistically from treatment with MTX. CONCLUSION: MTX is of no benefit in the treatment of PMR.

The triad of left hemiplegia, hemihypesthesia, and homonymous hemianopsia: implications for rehabilitation.

Patients with carotid cerebrovascular disorder can be categorized as having either right hemiplegia with various degrees of aphasia, left hemiplegia with hemihypesthesia, or homonymous hemianopsia, or the triad of left hemiplegia, hemihypesthesia and homonymous hemianopsia. The purpose of this study was to compare the functional performance of patients with each type of carotid cerebrovascular disorder before and 1 year after comprehensive rehabilitation aimed at improving communication and/or functional skills. Performance was measured using both the Barthel Index and Williams Drawing Test. On average, patients with the triad of neurologic deficits started and finished with poorer functional performance than the other patients. However, the average gain in functional scores over time was similar for all groups.