Canadian family physician Médecin de famille canadien
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The challenge of the limping child demands that the primary care physician identify those problems which are urgent, when neglect can harm the child, and to provide appropriate supportive care for those which are not. The approach to the limping child should consider the child's age, whether or not the limp is painful, and certain key physical findings.
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The hemostatic system consists of the subcutaneous tissue/vessel wall/platelet system and the coagulation cascade. Hemostasis occurs initially through the interaction between circulating platelets and subendothelial collagen, so that a platelet plug is formed. ⋯ The presence of the fibrin in the plug results in permanent hemostasis. The five tests of hemostasis - platelet count, bleeding time, partial thromboplastin time, prothrombin time and Factor XIII assay - are described.
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Urinary tract infections in females are discussed, emphasizing the need for urine cultures in diagnosis, and the importance of follow-up cultures and investigation in most patients if we are to decrease the morbidity and complications. Antibiotic therapy for acute and complicated infections, the role of long-term therapy, and the risks of catheterization are discussed.