Metal lawn and garden edging: the hidden knife?

OBJECTIVE: Lacerations account for many visits to the pediatric emergency department. We observed children presenting to local emergency departments in a large metropolitan area with lacerations incurred from metal lawn and garden edging, a landscaping tool. We sought to describe the severity of lacerations caused by metal edging, the characteristics of wound repair, and the need for subspecialty consultation. DESIGN: A retrospective chart review including all pediatric patients (< 18 years) presenting with lacerations caused by metal lawn and garden edging from January 1995 to October 1997 was performed. Patients were seen at one of three emergency departments in Colorado. RESULTS: One hundred twenty-six patients were enrolled (76% male, 24% female), with a median age of 9 years. The most frequent location of laceration was the foot (40%), followed by the knee (26%). The median length of laceration was 3 cm (range 1-22 cm). Sixteen patients (13%) received either intravenous or oral antibiotics, and six patients (5%) received orthopedic evaluation. CONCLUSIONS: Metal lawn and garden edging in landscaped neighborhoods presents a previously undescribed laceration danger to children. Some lacerations sustained from the metal lawn edging are extensive, receiving either multiple layer closure and/or the need for subspecialty consultation.

Use of propofol sedation in a pediatric emergency department: a prospective study.

The purpose of this study was to determine the efficacy and safety of propofol sedation for pediatric procedures in the emergency department. For patients needing painful procedures, propofol was administered intravenously. Vital signs, complications, and time to recovery were recorded. Patient amnesia and parent, patient, and operator satisfaction with sedation were assessed. The mean age was 7.4 years; 65% were male. Most underwent fracture reduction. Mean total dose was 3.3 mg/kg. Thirty percent experienced desaturation. One required assisted ventilation. Most had decreases in blood pressure. Mean recovery time was 18 minutes. Satisfaction with sedation was rated "excellent." Propofol was an effective sedation with minimal complications in the emergency department setting.

Are signs and symptoms associated with persistent corneal abrasions in children?

BACKGROUND: Corneal abrasions are common eye injuries in children. Most are treated with antibiotic drops or ointment, patching of the affected eye, and follow-up within 24 hours to confirm resolution by fluorescein examination. OBJECTIVE: To determine if signs and symptoms at follow-up were associated with the presence of a persistent corneal abrasion or abnormal visual acuity. DESIGN: Retrospective case series. SETTING: A children's hospital. PATIENTS: Children who were aged 4 years or older with the diagnosis of corneal abrasion between May 1992 and December 1996 and who had a follow-up examination. RESULTS: Seventy-seven patients (57% male) were enrolled (median age, 7 years). The respective sensitivities, specificities, positive predictive values, and negative predictive values of selective signs and symptoms for persistent abrasions were as follows: for pain, 53%, 93%, 80%, and 80%; for photophobia, 57%, 100%, 100%, and 80%; for redness, 100%, 46%, 44%, and 100%; for pain and redness, 40%, 96%, 80%, and 80%; and for at least 1 sign or symptom, 95%, 48%, 47%, and 95%. Twenty-six patients had persistent corneal abrasions at follow-up. Six of these 26 patients were symptom free at follow-up, and 15 patients had only redness as a persistent sign. Five patients had abnormal visual acuity, one of whom was asymptomatic. All 3 patients with complications were symptomatic. CONCLUSIONS: Signs and symptoms are inconsistently associated with persistent corneal abrasions. Asymptomatic patients may have persistent corneal abrasions, suggesting the need for selective follow-ups.

Localizing ingested coins with a metal detector.

This study was conducted to determine the utility of metal detection in coin localization by inexperienced operators, and determine the rate of spontaneous passage of asymptomatic esophageal coins. All children who presented to the emergency department of an urban children's hospital with a suspected coin ingestion were eligible. Coin location was predicted from metal detector results, while radiographs confirmed location. Asymptomatic patients with esophageal coins were observed for spontaneous passage. Ninety-one children (ages 9 months to 17 years) were prospectively enrolled. The metal detector had a sensitivity of 98% (53/54) in coin detection and 98% (81/83) in determining coin location as esophageal. Symptoms were poor predictors of coin location. Six of eight asymptomatic patients with esophageal coins spontaneously passed their coins. These results show that metal detection is a good screening test for coin presence and to determine coin location as esophageal. Spontaneous passage of asymptomatic esophageal coins warrants further study.

Cyclizine abuse by teenagers in Utah.

Substance abuse by teenagers is common, often involving use of alcohol and illicit drugs. Ingestion of cyclizine hydrochloride, a nonprescription medication, was noted to occur frequently in Utah for abuse reasons. A retrospective review was conducted of patients younger than 18 years of age over a 3-year period who intentionally ingested cyclizine identified from Utah Poison Control Center records. Eighty patients were included; 42 patients underwent hospital record review. Abuse accounted for 89% of cyclizine ingestions; hallucinations (70%) and confusion/disorientation (40%) were the most notable symptoms. Tachycardia (52%) and systolic hypertension (69%) were frequently present in patients who presented to a hospital. No serious complications occurred. This study illustrates teenage abuse of one nonprescription antihistamine presumably to induce hallucinations. Abuse of over-the-counter medications by adolescents may be more appealing than illicit drug use for numerous reasons, and may be more common than appreciated.

Embryonic lung morphogenesis in organ culture: experimental evidence for a proteoglycan function in the extracellular matrix.

The lung rudiment, isolated from mid-gestation (11 day) mouse embryos, can undergo morphogenesis in organ culture. Observation of living rudiments, in culture, reveals both growth and ongoing bronchiolar branching activity. To detect proteoglycan (PG) biosynthesis, and deposition in the extracellular matrix, rudiments were metabolically labeled with radioactive sulfate, then fixed, embedded, sectioned and processed for autoradiography. The sulfated glycosaminoglycan (GAG) types, composing the carbohydrate component of the proteoglycans, were evaluated by selective GAG degradative approaches that showed chondroitin sulfate PG principally associated with the interstitial matrix, and heparan sulfate PG principally associated with the basement membrane. Experiments using the proteoglycan biosynthesis disrupter, beta-xyloside, suggest that when chondroitin sulfate PG deposition into the ECM is perturbed, branching morphogenesis is compromised.

Embryonic salivary gland epithelial branching activity is experimentally independent of epithelial expansion activity.

Embryonic mouse submandibular salivary gland rudiments undergo morphogenesis in organ culture, characterized by extensive epithelial growth and expansion and repetitive branching activity. Tunicamycin, at a concentration of 25 ng/ml culture medium, decreases the degree of net protein accumulation by 83% and the degree of epithelial expansion by 70% compared to controls, over a 48-hr culture tenure. These decreases correlate with reduced incorporation of [3H]thymidine into DNA. Nevertheless, epithelial branching activity is uncompromised, undergoing an approximately 10-fold increase in lobe numbers, in both controls and tunicamycin-treated rudiments, during the same 48-hr period. The effect is most striking during the 24- to 48-hr culture interval, when controls and tunicamycin-treated rudiments each triple their lobe numbers and controls approximately double epithelial area, while tunicamycin virtually stops all epithelial expansion.

An autoradiographic analysis of N-linked glycoconjugates in embryonic salivary gland morphogenesis.

The synthesis, deposition, and loss of mannose-bearing glycoconjugates during branching morphogenesis of embryonic mouse salivary glands has been evaluated. Day 13 embryonic mouse salivary glands were cultured for 44 hr, pulse labeled 4 hr with [3H]mannose, then fixed after 0, 2, 4, 8, or 24 hr of chase in nonradioactive medium, and processed for autoradiography. Light microscopic autoradiograms of sectioned rudiments reveal extensive label within the epithelium, little label over the mesenchyme, and a concentration of radioactivity at the basal surface of the epithelium. Autoradiograms of "chased" rudiments reveal a) no detectable loss of label from the epithelium or the basal epithelial surface over the first 8 hr, and b) significant label loss by 24 hr of chase at the basal epithelial surface, while moderate amounts of radioactivity remain throughout the rest of the epithelium. The [3H]bound material is insensitive to chondroitinase ABC, a glycosaminoglycan degradative enzyme, but is sensitive to tunicamycin presence in the culture medium. Earlier studies showed that embryonic mouse salivary glands cultured in medium containing tunicamycin (25 ng/ml) continued normal epithelial branching while epithelial growth was inhibited. The present autoradiographic studies of [3H]mannose-labeled rudiments demonstrate that tunicamycin causes a significant decrease in radioactivity, relative to controls. Thus, our results suggest that epithelial branching activity is independent of control levels of mannose-containing/tunicamycin-sensitive, glycoconjugate deposition.