The continuing problem of all-terrain vehicle injuries in children.

BACKGROUND: After the introduction of the all-terrain vehicle (ATV) in the United States in 1971, deaths and injuries in both adults and children rose dramatically. In 1988, the Consumer's Product Safety Commission (CPSC) and all manufacturers of ATVs signed legally binding "Consent Decrees," designed to decrease the number of ATV-related deaths and injuries, especially in children. METHODS: This report reviews retrospectively the mechanism of injury as well as the injuries in 51 children caused by ATV crashes during a 5-year period after the signing of the decrees. RESULTS: Data included age; sex; type of ATV (three or four wheel); position of the patient on the vehicle (driver or passenger); helmet usage; and mechanism of vehicular accident, including collision with a stationary or moving object, rollover, or fall from the vehicle. Mechanism data indicate loss of control of vehicle or fall from the vehicle as the most common cause of injury. Injury statistics included body regions and parts injured, injury severity score (ISS), and complications or disabilities resulting from injury. Mean ISS was 13.6 +/- 9.7 (range, 1 to 50). Eighteen patients (35%) had ISSs greater than 15. Helmets were worn by only 30% of patients. There were two deaths, and two patients suffered permanent paralysis. Orthopedic injuries were the most common injury and were of adult type with 61% classified as open or comminuted. CONCLUSIONS: The magnitude and severity of these injuries argue that this recreational vehicle is exceedingly dangerous for children. The consent decrees have had little effect on reducing the injuries in children from ATVs and should be reevaluated.

Concise parathyroidectomy: the impact of preoperative SPECT 99mTc sestamibi scanning and intraoperative quick parathormone assay.

BACKGROUND: Results of initial operation for sporadic primary hyperparathyroidism are generally excellent, yet today there is pressure to improve outcome and resource utilization. METHODS: We designed a prospective longitudinal cohort study comparing two approaches to concise parathyroidectomy. Strategy A was defined as the palpation method for selective unilateral exploration. Strategy B was defined as the routine use of both preoperative 99mTc sestamibi single photon emission computed tomography (SPECT) imaging and intraoperative quick parathormone assay. With either strategy the study period was 19 months and patients explored unilaterally were candidates for same-day discharge. We compared surgical outcome for 128 consecutive consenting patients each with 6 months or more of follow-up (mean 12 +/- 7.6 months). RESULTS: Demographic, biochemical and pathologic findings did not differ between groups. SPECT imaging precisely localized hyperfunctioning parathyroid tissue. Compared with Strategy A (n = 61), the 67 patients treated by use of Strategy B experienced a higher rate of unilateral exploration (41.0% versus 62.7%, p < 0.00001) and a shorter length of stay (1.07 versus 1.90 days, p < 0.00001) and tended to have shorter operative times, fewer operative failures, and less morbidity. Total perioperative costs did not differ between groups. CONCLUSIONS: Routine use of intraoperative quick parathormone measurement and preoperative 99mTc sestamibi SPECT is as safe, effective, and cost-effective as conventional approaches to parathyroidectomy. Use of this strategy is associated with significant reductions in extent of surgery and length of hospital stay.

Left main bronchus compression after arterial switch for transposition.

A case of left main bronchus obstruction after an arterial switch is described. The clinical features and successful management are described, and a mechanism for this complication is proposed.

Thoracoscopic instruments and ancillary equipment.

Thoracoscopic instruments of today are rooted in surgical innovations which began over 100 years ago. The advent of modern video-optical equipment and endoscopic techniques has given birth to a wide array of new instruments and surgical uses. This process is still in full swing. An overview of the most important developments is given, and future lines of development are explored.