Ice-cream truck-related injuries to children

In previous work, we and others have shown that serum levels of alpha-fetoprotein, human chorionic gonadotropin, and estriol vary among the four commonly defined racial/ethnic groups seen in the United States: white, African-American, Asian, and Hispanic. We have suggested that better sensitivity and specificity could improve screening sensitivity and specificity. However, it has been argued that systematic weight differences among the groups could explain the variation. We evaluated the results from 208,257 patients having screening and found systematic weight differences. However, these differences were not as large as the racial/ethnic differences, showing that weight does not fully explain the discrepancy, and, therefore, four separate data bases give more accurate results.     

Anesthesia and analgesia for minor injuries to children

Today's children are rambunctious, playful, and aggressive and are provided through the miracles of modern technology with ample opportunities to injure themselves. As such, they are a source of both joy and terror to their parents. It is a "given" that many of them will injure themselves in the course of growing up. When they come to us in the ED waiting room, they are typically very frightened and usually in pain. We are fortunate that we have techniques and drugs to alleviate this pain and to attenuate their fear. It is our responsibility as anesthesiologists to ensure that these drugs and techniques are used appropriately and cause no further harm. We hope the information contained in this chapter may be of benefit in achieving this goal.     

Minor oral injuries in children

Traumatic injuries involving the oral cavity in children often result from falls or collisions with stationary objects. Repair of lacerations involving the soft tissue structures within the oral cavity is described. These injuries often can be managed by emergency department personnel, with referral to an oral and maxillofacial surgeon for follow-up care. Initial management of more extensive injuries such as dentoalveolar fractures, penetrating injuries and burns is also described. Immediate consultation with the appropriate specialist is suggested, because significant deformity and/or morbidity may result from minor oral injuries.     

Blaming children for child pedestrian injuries

Pedestrian injuries are a leading cause of childhood mortality. In this paper a case study of a child pedestrian death is presented in order to examine the apportionment of responsibility for child pedestrian injuries. The case presented illustrates how responsibility is located with the child, whilst structural contributors, in particular aspects of the transport system, are ignored. The strength and pervasiveness of the ideology of victim blaming in child pedestrian injuries is explained by the special position that the road transport system holds in relation to dominant economic interests. Victim blaming ideology is a strategy that serves to maintain these interests at the expense and suffering of children. Increased recognition of the political roots of the ideology of victim blaming in child pedestrian injuries, by the sectors of the community who suffer its consequences, will be an important step towards effective preventive action.     

Lower extremity lawn-mower injuries in children

Lower extremity lawn-mower injuries in children result in significant morbidity with a significant financial burden to the family and society. We reviewed 24 children with lower extremity lawn-mower injuries; all mothers completed standardized psychologic assessments of their children, and 18 children were interviewed. Fifty percent of the mothers had defensive profiles on the standardized psychologic assessment, suggesting the likelihood of denial or underreporting of the child's psychologic difficulties. Therefore, we found the interview with the child to be a more accurate measure of psychologic distress. Prevention measures aimed at parents must emphasize that a child must not be allowed in a yard that is being mowed with a riding mower.     

Submersion injuries in children and adults

Drowning and near drowning remain a common cause of childhood death and disability. Toddlers aged one through four drown in private swimming pools. Submersions greater than 10 minutes and lack of CPR at the scene or the need for greater than 20 minutes of resuscitation portends a poor prognosis. Management of respiratory failure without neurologic impairment has the most successful outcome. Prevention of drowning morbidity is dependent on constant parental supervision, and immediate and expert CPR.     

Fatal and hospitalized agricultural machinery injuries to children in Ontario, Canada

Expression of nucleoside diphosphate(NDP) kinase, which is homologous to the nm23 gene product in a variety of species, has been found to be inversely associated with metastatic potential. However, the relationship remains controversial according to the tumor cell types and experimental system, with conflicting results from different research groups. In order to determine whether NDP kinase expression serves as a marker for metastatic potential in human skin cancer, we assessed the levels of NDP kinase expression in 9 keratoacanthomas (KAs), 26 squamous cell carcinomas (SCCs), and 25 basal cell carcinomas (BCCs) using immunohistochemistry. The expression of NDP kinase was intense in KA and SCC compared with BCC. However, the difference of NDP kinase expression between KA and SCC was not statistically significant. And there was no statistically significant difference in NDP kinase expression between SCC with metastasis and SCC without metastasis. Our results contradict the hypothesis concerning the possible role of nm23 gene as a metastatic suppressor gene in human skin cancer. The mechanism of overexpression in various tumor cell types and its biological significance in cutaneous carcinogenesis remain to be determined.     

Behavioral determinants of mothers' safety measures to prevent injuries of pre-school children

Home-related injuries are a major threat to pre-school children in the western world. In this study the behavioral determinants of 18 parental safety measures were assessed. To select behavioral determinants, the Attitude-Social influence-Self-efficacy/barriers model was used with the inclusion of variables from the Health Belief Model and the Protection Motivation Theory. A written questionnaire was completed by 1129 Dutch mothers of pre-school children. Most safety measures were explained (rather) well by the same set of determinants. Main determinants for adopting or not adopting a safety measure were the mother's belief in the necessity of the safety measure according to the child's age, her belief about her partner's opinion on the necessity and her belief about the success of taking the measure. Subsequent important determinants were the mother's belief about the inconvenience and instrumentality of the safety measure; the perceived susceptibility had a minor or moderate influence on most measures. This study did not indicate that more highly educated mothers were more knowledgeable about safety-related subjects. The theoretical implications of this study are discussed.     

A randomized trial of an intervention to prevent lawnmower injuries in children

Siberian hamsters (Phodopus sungorus sungorus) undergo photoperiod-induced physiological and behavioral adaptations. These adaptations, including changes in reproductive and metabolic status, are triggered by the pineal gland through the nocturnal secretion of its principal hormone, melatonin. The possible CNS sites of melatonin action determined through radiolabeled melatonin binding include the paraventricular and reuniens nuclei of the thalamus and the suprachiasmatic nucleus (SCN). However, we do not know the mechanisms and circuitry involved in the transmission of melatonin signals. Bilateral electrolytic lesions of the SCN (SCNx) block the responses to short day-like (long duration) melatonin signals delivered daily via the timed infusion paradigm, suggesting that the SCN receives and transmits short-day melatonin signals. The purpose of the present experiment was to answer the following question: are short-day melatonin signals transmitted to other brain structures from the SCN through its dorsomedial/dorsocaudal fiber projections? Pinealectomized adult male hamsters given horizontal knife cuts (kc) just dorsocaudal to the SCN (SCN-kc), sham-kc, or SCNx were given daily subcutaneous short day-like melatonin infusions via the timed infusion paradigm for 6 weeks. Only the hamsters given SCNx exhibited long day-like gonadal, epididymal fat pad, and body masses. Therefore, short day melatonin signals received by the SCN were not transmitted to other areas of the central nervous system through SCN efferents projecting dorsomedially or dorsocaudally.     

Extremity handgun injuries in children and adolescents

The majority of gunshot wounds in the urban pediatric population are inflicted by handguns. This study reviewed the trauma center management of 66 handgun injuries to the upper and lower extremities among 51 children who were aged < or =16 years. As expected, gunshot wounds were more frequent in adolescent males and were usually intentional. About half of the children had police records prior to the gunshot wounds. Fifty-two percent of the extremity handgun injuries resulted in fractures, most commonly to the tibia or forearm. Seventy-nine orthopedic procedures were recorded with an average hospital stay of 4.3 days. Permanent morbidity was undoubtedly underestimated due to poor long-term follow-up.     

Preschool children at risk for repeat injuries

BACKGROUND: Nitric oxide (NO) is cytostatic for proliferating cells, inhibits microbial growth, and down-regulates the synthesis of specific proteins. Studies were undertaken to determine the mechanism by which NO inhibits total protein synthesis and whether the inhibition correlates with established cytostatic activities of NO. MATERIALS AND METHODS: In in vitro experiments, various cell types were exposed to NO using either donors or expression of inducible NO synthase (iNOS). The capacity of NO to suppress total protein synthesis, measured by incorporation of 35S-methionine into protein, was correlated with the capacity of NO to suppress cell proliferation, viral replication, or iNOS expression. Phosphorylation of eIF-2 alpha was examined as a possible mechanism for the suppressed protein synthesis by NO. RESULTS: Both NO donors and expression of the iNOS suppressed total protein synthesis in L929 cells and A2008 human ovarian tumor cells in parallel with decreased cell proliferation. Suppressed protein synthesis was also shown to correlate with decreased vaccinia virus proliferation in murine peritoneal macrophages in an iNOS-dependent manner. Furthermore, iNOS expression in pancreatic islets or RAW264.7 cells almost completely inhibited total protein synthesis, suggesting that nonspecific inhibition of protein synthesis may be the mechanism by which NO inhibited the synthesis of specific proteins such as insulin or iNOS itself. This possibility was confirmed in RAW264.7 cells where the inhibition of total protein synthesis correlated with the decreased iNOS protein. The decrease in protein levels occurred without changes in iNOS mRNA levels, implicating an inhibition of translation. Mechanistic studies revealed that iNOS expression in RAW264.7 cells resulted in the phosphorylation of eIF-2 alpha and inhibition of the 80S ribosomal complex formation. CONCLUSIONS: These results suggest that NO suppresses protein synthesis by stimulating the phosphorylation of eIF-2 alpha. Furthermore, our observations indicate that nonspecific inhibition of protein synthesis may be a generalized response of cells exposed to high levels of NO and that inhibition of protein synthesis may contribute to many of the described cytostatic actions of NO.     

Subcutaneous injuries of the duodenum in children

In Child Surgery clinics of the Leningrad City since 1955 to 1974 eight children, aged from 3 to 15 years, were operated upon for this kind of trauma. The diagnosis of duodenal injuries intraoperatively is based on the presence of retroperitoneal hematoma, emphysema in the retroperitoneal space, yellow-green staining of the posterior peritoneal leaf.     

Electroroentgenography in children with nose injuries]

The authors conducted electroroentgenography for diagnostics of nasal bone fractures in 55 children aged from 5 to 15. They studied altogether 78 electroroentgenograms comparing them with 61 roentgenograms. Comparing the number and quality of details of nasal traumas revealed by roentgenography and those revealed by electroroentgenography the authors obtained evidence showing that the electroroentgenographic method of investigation was more accurate in diagnosing this pathology. Electroroentgenograms reveal details of destruction both of the osseous structure of the external nose and that of the osteo-cartilaginous structure of the nasal septum and the surrounding soft tissues. The authors recommend to use the electroroentgenographic method for diagnostics of traumatic lesions of the nose in children.     

An epidemic of roller-blade injuries in children

Roller blading is a new and increasingly popular leisure activity in many countries. We reviewed 110 consecutive patients with roller-blade injuries between 1 January and 30 June 1996. The patients ranged from 4 to 14 years in age (mean 6.5 years). Eighty-three (75.4%) sustained injuries to the upper limb and 27 (24.5%) injured the lower limb. Fifty-six patients, were girls and 54 were boys. Of the 110 patients, 79 (72.7%) sustained fractures, 28 (25.4%) soft tissue injuries and 3 (2.7%) dislocations. Eighty-three (75.4%) of the patients wore no protective equipment on the limbs. Four months following injury 103 (93.6%) patients were fully recovered. The mean duration of school absence was 3 days. Subsequently 101 children returned to using roller-blades following injury. Seventy-three (66.3%) of these now use protective equipment. We found that injuries were unrelated to age or duration of roller-blading experience or to the brand-name of roller blades used, and that most of our patients wore no protective equipment at the time of injury.     

Magnetic resonance imaging of knee injuries in children

The appearances of knee injuries on MR imaging are less well documented in children than adults. Some patterns of injury are shared by both groups of patients, e. g. meniscal damage. The frequency of specific injuries may differ, e. g. anterior cruciate ligament (ACL) tear. Congenital abnormality, coexistent pathology and previous treatment of the knee appear to be associated with meniscal problems. Discoid menisci are seen most frequently in children and have unique features on MR scans. Cruciate ligament tears are difficult to diagnose in the smallest children. The ACL may not be identified due to its small size. Normal bone marrow signal may be confused with marrow infiltration or bone microfracture. Radiographically occult fractures around the knee appear to be strongly associated with ligamentous injury as in adult patients. Osteochondral fractures, osteochondral lesions and articular cartilage damage are revealed on MR scans, but their long-term effects are uncertain. It is possible to diagnose a range of knee injuries on MR scans in children. The biggest diagnostic challenge is in pre-school children.