A one-year series of pediatric ED water-related injuries: the Hawaii EMS-C project.

During a 12-month period ending on November 30, 1988, data on 133 pediatric patients visiting a pediatric emergency department with water-related injuries were collected. Of these patients, 70% were male. There were 13 submersions, seven cases of head trauma, three cases of neck trauma, 88 cases of external injury, and 34 other injuries. Incidents took place at beaches (75%) in public pools (12%), in friends' pools (4%), and in home pools (4%). Eighty-six percent of the cohort knew how to swim. Swimming, playing, and surfing activity accounted for most of the injuries. Measures for prevention are described.     

Serratus anterior muscle transplantation for treatment of soft tissue defects in the hand

The inferior three slips of the serratus anterior muscle have been used as a free tissue transfer in 18 patients for the reconstruction of dorsal and palmar defects in the hand. Mean follow-up was 2.8 years. There were 12/18 flaps for palmar coverage and 6/18 for dorsal coverage. All flaps survived. On the basis of this experience we conclude that this flap has three attributes making it suitable for palmar and dorsal metacarpal resurfacing: (1) low donor site morbidity, (2) the three separate slips are easily divisible for contouring, and (3) durability and adhesion provide a stable resurfacing for grasp.     

Arthroscopic tarsometatarsal (Lisfranc) arthrodesis

We describe an arthroscopic approach of tarsometatarsal arthrodesis for post-traumatic arthritis. Five tarsometatarsal portals (medial, P1–2, P2–3, P3–4, P4–5) are identified at the junctional points between the metatarsals by means of image intensifier. The first metatarsocuneiform joint is approached through the medial and P1–2 portal. Articular cartilage is denuded and micro-fracture of subchondral bone is performed with an arthroscopic awl. The second metatarsocuneiform joint is approached through the P1–2 and P2–3 portals and the third metatarsocuneiform joint is approached through the P2–3 and P3–4 portals. The articular surfaces are prepared for arthrodesis. The articulations are kept in desired position and transfixed with 4.0 mm cannulated screws. The fourth and fifth metatarsocuboid articulations are rarely included in the procedure. Arthroscopic arthrodesis or tendon arthroplasty of the lateral column can be performed through the P3–4 and P4–5 portals.     

The dietary intake of homeless males sleeping rough in Central London

Data concerning the food and beverage intake (including alcohol) of 79 males, aged 19–50 years, sleeping rough in Central London, who did not appear to be under the influence of drink, drugs or suffering from mental illness were collected by prompted 24-h recall and food-frequency questionnaire (FFQ). The source of food was noted and the subjects were asked about food availability and food needs. The group had intakes significantly lower than Dietary Reference Values (DRV) for the UK for energy, carbohydrate, non-starch polysaccharides (NSP), folate, zinc and magnesium. Significantly higher values were seen for protein, fat, vitamin B₁₂, calcium and iron. Alcohol intake was higher than that assumed to approximate current intakes of the UK population. Mean macronutrient intakes for the group were similar to means for British adult men (OPCS, 1990), only protein and NSP were significantly lower. The FFQ showed very low consumption/week of fruit, vegetables, salad, fruit juice and wholewheat/brown products. Organized charities provided the major source of food energy for the group as a whole. Self-supplied sources provided the major source of total energy. It is suggested that the group may benefit from an increase in dietary fibre and energy, with an increase in the proportion of energy supplied by carbohydrate and a reduction in energy from fat and alcohol. A varied supply of food and hot meals during weekends as well as during the week may benefit the group both aesthetically and nutritionally. It may be advisable to increase the supply of wholemeal/brown bread, fruits, vegetables and salad foods without decreasing the energy content of the food available.