A key to effective control of childhood injuries

Abstract Injuries account for 50% of deaths in Australian children aged 1-14 years, and are a major cause of hospital admission and disability. Injury surveillance systems involving the establishment of ongoing, systematic collection and analysis of data relevant to injury prevention and trauma management have a critical role in the effective control of the injury pandemic. Contemporary Australian initiatives including the establishment of the National Injury Surveillance and Prevention Project, new national public health programmes and research initiatives have the potential to establish a new wave of injury control programmes on a firm scientific base.     

Morphine consumption and respiratory depression in children receiving postoperative analgesia from continuous morphine infusion or patient controlled analgesia

Thirty children, aged between five and 15 years, were randomly allocated to receive postoperative analgesia from continuous morphine infusion (CMI) or patient controlled analgesia (PCA), also using morphine. The children's morphine consumption, respiratory rates, oxygen saturations and observation points during which they were sleeping were recorded during two periods, one on the day of operation and one the following day. The median dose of morphine consumed by the children using PCA was significantly larger than that consumed by the children having continuous infusions. Children aged between nine and 15 years using PCA had significantly lower minimum respiratory rates and minimum oxygen saturations than similarly aged children receiving continuous infusions. There was no significant difference between the PCA and CMI groups in the number of observation times that the children were asleep or in the minimum respiratory rates and minimum oxygen saturations in the awake and sleeping children.     

Patterns of femoral head migration in osteoarthritis of the hip: a reappraisal with CT and pathologic correlation

Although medial, superior, and axial patterns of migration of the femoral head in osteoarthritis of the hip have been well described, it is not clear what anatomic and biomechanical factors determine the direction of migration. The authors studied 22 patients with bilateral (11 patients) or unilateral (11 patients) osteoarthritis by means of conventional radiography and computed tomography (CT) to define any relationships between migration in the coronal plane and that in the transverse plane and to determine whether femoral anteversion, acetabular anteversion, femoral neck-shaft angle, or acetabular inclination were related to particular migration patterns. Anterior migration was evident in 14 of the 19 hips with a superior migration pattern, whereas posterior migration was present in five of the seven hips with a medial migration pattern. In the remainder of cases, no migration in the transverse plane was present. Femoral anteversion as determined with CT, femoral neck-shaft angle, angle of acetabular inclination, and acetabular anteversion angle in this relatively small sample were all found to be within normal limits and appeared to have no influence on the occurrence of a specific pattern of femoral head migration.     

Automated precordial mapping for S-T segment analysis: Variability in serial mappings of normal subjects and patients with stable S-T elevation

An automated method of precordial mapping using a modified Caceres U. S. Public Health Service Electrocardiogram Diagnosing Program has been developed. The S-T segment elevation was measured in three successive complexes and averaged for each of the 35 precordial leads. The onset of the S-T segment (J point) was accurately located in over 99 percent of instances. The time required to sample the 35 leads averaged 8 1/2 minutes with subsequent data analysis requiring an additional 7 minutes. The S-T segment variability between serial mappings done over a 1 to 2 hour period was determined in normal subjects and patients with stable S-T elevation. The average S-T segment elevation/35 leads in normal subjects was 1.28 mv (range 0.41 to 2.14) and the betweenmapping variability was ±0.25 mv at the 95 percent confidence level. The average S-T segment elevation/35 leads in the patients was 4.01 mv (range 1.35 to 7.28) mv. The between-mapping variability was ±0.29 mv (95 percent confidence level), and was not statistically different from the variability in normal subjects (P < 0.05).     

The Oxford Miniature Vaporizer in paediatric anaesthesia. An experimental study

An experimental study of the Oxford Miniature Vaporizer in combination with a paediatric resuscitation bag has demonstrated efficient halothane vaporization at small tidal volumes. This technique will be appropriate in paediatric anaesthesia with the Triservice apparatus.     

An additional tactile test

An additional clinical test to confirm laryngeal placement of tracheal tubes is described. Using the new test, placement was confirmed in all of 50 patients studied in whom difficulty would have been anticipated using previously described tactile tests (male patients with lower molar teeth). Two anaesthetists with small hands averaged 98% confirmations in two series each of 100 consecutive unselected intubations. A simple modification of the tests enables their application after nasotracheal intubation; even with small hands, a confirmation rate of 96% in 50 consecutive cases was found. The three tactile tests are reviewed and analysed. In the authors' combined experience of 14 cases of difficult laryngoscopy the tests gave reliable confirmation in 12 patients. Familiarity with these tests is stressed to be important for their reliable implementation.     

Protein secretions in hamsters with pancreatic carcinoma

Pancreatic secretions from the hamster model for pancreatic ductal adenocarcinoma were analyzed to determine whether alterations had occurred in the protein composition. CCK- and secretin-stimulated secretions were collected from 13 animals with cancer and 16 normal controls. Subsequent separation of the proteins by isoelectric focusing showed the following: (1) Significant changes occurred in the protein composition from animals with carcinoma. An unusually dark band was present at pH 7.5 just below amylase (pH 7.65); two unidentified bands, present in the normals at pH 6.9 and 7.0, were missing; and marked decreases occurred in the cathodic proteins with isoelectric points above pH 9. (2) CCK provided the optimal stimulus for differentiating specimens from animals with carcinoma from the normal controls. (3) The protein concentrations of CCK-stimulated secretions of animals with carcinoma were significantly lower than the controls. We have concluded that the protein alterations which have occurred in the hamster model for pancreatic ductal adenocarcinoma warrant further investigation.