Suffocation, choking, and strangulation in childhood in England and Wales: epidemiology and prevention

The causes, classification, and prevention of mechanical asphyxial death in children were examined. The Office of Population Censuses and Surveys (OPCS) identified children, under 15 years of age, who had died as a result of choking, suffocation, or strangulation in England and Wales during the years 1990 and 1991. Cases in the International Classification of Diseases (ICD) codes of E911-3, E953, E963, and E983 were selected and case details from HM coroners' records and the death certificates were extracted. The OPCS identified 136 children (99 boys, 37 girls) in the two year period, 65% were under 3 years of age. The children were classified as dying from choking (21 cases), aspirating gastric contents (39 cases), suffocation (29 cases), strangulation (11 cases), and hanging (36 cases). The strangulation cases could be further subdivided into a group of 12 younger children who were suspended from ligatures around the home and a group of 21 boys (8-14 years) who died of self initiated hanging. Overall, 11 children were deliberately killed and 31 children died in beds or cots. Children whose deaths are classified as being due to aspiration of vomit appear to be cases of the sudden infant death syndrome or background medical conditions. This study suggests the need for advice on maintaining a safe sleeping environment. Only one child choked on a toy and European Standards for Toy Safety appear to have been successful. The prevention of hanging in the group of older boys needs further exploration.     

Anatomic basis of venous drainage in gastric tubular esophagoplasty

Summary This study was made with the aim of specifying the general architecture of the venous system of the stomach and its mode of drainage under normal conditions, and also of investigating the role of the venous drainage in the origin of disunion, anastomotic fistula and structure after tubular esophagoplasty pedicled on the right gastroepiploic vessels. Sixty stomachs removed from fresh cadavers were studied by injection-corrosion, using colored Altufix P₁₀ as the injection mass. 35 specimens were injected globally via the superior mesenteric v., 15 by the same route but after clamping of the splenic, left gastric and right gastric vv., which corresponds to the technique of gastrolysis performed in esophagoplasty, and 10 were injected simultaneously with media of four different colors via the left gastric, right gastric, superior mesenteric and splenic vv. to define their respective territories. Also studied were the origin, course, termination, territory and caliber of the main gastric veins. Analysis of the results confirmed the richness of the venous anastomoses of the stomach, effected on the one hand between the two extraparietal arches at the greater and lesser curvatures, and on the other by intraperitoneal communications arranged perpendicular to these two arches. It emerges that the right gastroepiploic v. cannot always ensure drainage of the entire stomach. The factors involved are discussed. The risk of venous stasis in gastric esophagoplasty must always be borne in mind.

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Bases anatomiques du drainage veineux dans l'oesophagoplastie gastrique tubulée

Résumé Ce travail a été effectué dans le but de préciser l'architecture générale du système veineux de l'estomac et son mode de drainage dans des conditions normales. Il est aussi motivé par la recherche du rôle du drainage veineux dans la genèse des désunions, des fistules anastomotiques, des sténoses après oesophagoplastie tubulée pédiculisée sur les vaisseaux gastro-épiploïques droits. 60 estomacs prélevés sur des cadavres frais ont été étudiés par la méthode d'injection-corrosion. Le produit utilisé est l'Altufix P₁₀ coloré. 35 pièces ont été injectées globalement par la veine mésentérique supérieure, 15 pièces par la même voie mais après clampage de la veine splénique, de la veine gastrique gauche et de la veine gastrique droite, ce qui correspond a la technique de gastrolyse effectuée pour oesophagoplastie, et 10 ont été injectées simultanément par les produits colorés en quatre couleurs par les veines gastrique gauche, gastrique droite, mésentérique supérieure et splénique (ou liénale) pour préciser leur territories correspondants. L'origine, le trajet, la terminaison, le territoire et le calibre des principales veines de l'estomac ont été étudiés. L'analyse des résultats permet de confirmer la richesse des anastomoses veineuses de l'estomac qui s'effectuent d'une part, entre deux arcades extrapariétales au niveau de la grande et de la petite courbure, et d'autre part au niveau de communications intrapariétales disposées perpendiculairement à ces deux arcades. Il apparaît que la veine gastro-épiploïque droite ne peut pas toujours assurer le drainage de la totalité de l'estomac. Les facteurs influençants sont discutés. Le risque de stase veineuse dans l'oesophagoplastie gastrique doit toujours être pris en compte.

     

Primary Sjögren's syndrome: salivary gland function and clinical oral findings

OBJECTIVE: To evaluate salivary gland function, saliva composition and oral findings in patients with primary Sjogren's syndrome (pSS) subdivided into patients with and without focus score ≤1 (FS) and/or antibodies to SSA/SSB (AB) as well as in healthy controls. SUBJECTS AND METHODS: Unstimulated (UWS) and chewing stimulated (SWS) whole saliva, and stimulated parotid saliva (SPS) were collected in 16 patients fulfilling the European classification criteria for pSS subdivided into those with FS and/or AB (n= 8) and those without FS and AB (n= 8), and in age-matched (n= 14) and young healthy controls (n= 13).UWS and SWS were analysed for Na⁺ and K⁺.SPS was analysed for Na⁺, K⁺, statherin, and proline-rich proteins (PRPs).Sicca symptoms, DMFT/DMFS, plaque (PI) and gingival (GI) scores, periodontal pocket depth (PPD), and mucosal status were recorded. RESULTS: The young healthy controls had lower UWS as compared to the aged controls (P= 0.03).However, the aged controls had higher DMFT/DMFS (P < 0.001) and PI, GI and PPD (P < 0.01).Patients with FS and/or AB generally had lower saliva secretory rates than patients without FS and/or AB (P= 0.01 for UWS and SPS) and age-matched healthy controls (P= 0.001). There was no significant difference in the content of Na⁺ and K⁺, statherin and PRPs between groupS. Patients with FS and/or AB had the highest frequency of oral mucosal changes and higher DMFT/DMFS than patients without FS and/or AB and healthy controls (P < 0.01).However, PI, GI, and PPD did not differ significantly. CONCLUSION: Patients with FS and/or AB had lower salivary secretory rates, higher DMFT/DMFS, and more oral mucosal changes than patients without FS and/or AB.Additionally, data suggest that salivary gland function in healthy individuals do not decrease with age.     

Understanding the experience of inpatient rehabilitation: insights into patient‐centred care from patients and family members

The aim of the study was describe the experiences, needs and preferences of recent inpatients of a rehabilitation centre, and the needs of their families. Data were collected in four focus groups, two with patients (n = 13) who had recently completed inpatient rehabilitation following an illness, injury or elective surgery, and two with family members (n = 11). During the focus groups, two researchers facilitated discussion on any topic that participants considered important to the experience of inpatient rehabilitation; participants were encouraged to describe their care, needs and preferences. The focus group discussions were audio‐taped and transcribed verbatim. Field notes were hand recorded. Data were analysed and collated into themes. Six key themes emerged. Participants wanted: interactions with friendly, empathetic staff; regular contact with senior staff and all staff to introduce themselves by name and profession; timely communication of accurate information; and rehabilitation services seven days a week. The physical environment had both positive and negative effects on patient well‐being. Patients with complex or atypical circumstances required special attention to ensure their needs were met. In conclusion, patients and families identified six important issues that need to be considered during inpatient rehabilitation.     

Early versus delayed treatment of extension type-3 supracondylar fractures of the humerus in children

We examined differences in the rate of open reduction, operating time, length of hospital stay and outcome between two groups of children with displaced supracondylar fractures of the humerus who underwent surgery either within 12 hours of the injury or later. There were 77 children with type-3 supracondylar fractures. Of these, in 43 the fracture was reduced and pinned within 12 hours and in 34 more than 12 hours after injury. Both groups were similar in regard to gender, age and length of follow-up. Bivariate and logistical regression analysis showed no statistical difference between the groups. The number of peri-operative complications was low and did not affect the outcome regardless of the timing of treatment. Our study confirmed that the treatment of uncomplicated displaced supracondylar fractures of the humerus can be early or delayed. In these circumstances operations at night can be avoided.     

Partial anomalous pulmonary venous drainage of the right lower lobe shown by CT scans

A case is reported in which the diagnosis of partial anomalous pulmonary venous return was first suggested on computed tomographic (CT) scans. Abnormal pulmonary vessels could be seen on serial CT sections to drain into the superior vena cava. The diagnosis was confirmed at angiographic study.